Active NPI
Christopher Mattimore, CASAC
- Addiction (Substance Use Disorder) Counselor
- Medford, NY
National Provider Identifier
1205259868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 23778
- Practice address
- 3251 Route 112
BLDG. 9, Ste. 2
Medford, NY 11763-1446 - Phone
- (631) 451-6007
- Fax
- (631) 297-8121
- NPI assigned
- Jan 31, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 23778 | NY | Primary |
Addresses
Primary practice location
3251 Route 112
BLDG. 9, Ste. 2
Medford, NY 11763-1446
Mailing address
10 W 21St St
Deer Park, NY 11729-3918
Phone (631) 949-1257
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23778 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391731200000",
"number": "1205259868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 W 21ST ST",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117293918",
"telephone_number": "631-949-1257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3251 ROUTE 112",
"address_2": "BLDG. 9, STE. 2",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631446",
"telephone_number": "631-451-6007",
"fax_number": "631-297-8121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTIMORE",
"first_name": "CHRISTOPHER",
"name_prefix": "Mr.",
"credential": "CASAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-31",
"last_updated": "2014-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "23778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.