Ivan A Matthew Jr., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

084938 Issued in NY

Practice address

223 Mystic LN
Rochester, NY 14623-5448

Phone

(585) 576-4830

NPI assigned

May 16, 2022

Last updated

May 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stephanie Jackman LCSW PLLC

  • Clinical Social Worker
  • Rochester, NY
  • NPI 1427663269
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1245977768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 MYSTIC LANE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146235448",
            "telephone_number": "585-576-4830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 MYSTIC LN",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146235448",
            "telephone_number": "585-576-4830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Wellington Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146191210",
            "country_code": "US",
            "telephone_number": "585-358-0512",
            "fax_number": "585-861-6827",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "223 Mystic Ln",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146235448",
            "country_code": "US",
            "telephone_number": "585-576-4830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTHEW",
        "first_name": "IVAN",
        "middle_name": "A",
        "name_suffix": "Jr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "084938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara E Matteson-Rusby, PHD
• Jalen Tylar Matteson, MD
• Matthew C Sharpe Nurse Practitioner in Psychiatry PLLC
• Matthew Schirmer (Rochester Pain and Performance)
• Matthew Teal LCSW PLLC (Rochester Counseling Group)
• Glenmarie Aniece Matthews, M.D.
• Jonee Matthews
• Kristen Matthews, FNP
• Lee Matthews, ATC
• Saarai Khaalilly Matthews, L.P.N.

• Clinical Social Worker in Rochester, NY
• Providers in Rochester, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.