Provider Demographics
NPI:1902630726
Name:MATASSA, BRANDON (MHC-LP; MSED)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MATASSA
Suffix:
Gender:M
Credentials:MHC-LP; MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HALFMOON RD APT D
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1110
Mailing Address - Country:US
Mailing Address - Phone:516-305-2968
Mailing Address - Fax:
Practice Address - Street 1:33 HENRY ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3006
Practice Address - Country:US
Practice Address - Phone:845-235-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health