Individual provider Active NPI

Kirk Denys Matefy, LCSW

  • Clinical Social Worker
  • Bridgeport, CT
National Provider Identifier
1649879602
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11217 Issued in CT
Practice address
2157 North Ave
Bridgeport, CT 06604-2438
Phone
(203) 335-0345
NPI assigned
Oct 21, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 11217 CT Primary

Addresses

Primary practice location

2157 North Ave
Bridgeport, CT 06604-2438

Mailing address

2157 North Ave
Bridgeport, CT 06604-2438
Phone (203) 335-0345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20240216001228 CT Practitioner - Clinical Social Worker 2163866252 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11217CTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kirk Denys Matefy Clinical CurrentSince Nov 14, 2025 Accepting new patients
Psychological Associates LLC Clinical CurrentSince Dec 18, 2023 Accepting new patients

Locations

2157 North Ave
Ste 1
Bridgeport, CT 06604

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763078400000",
    "number": "1649879602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2157 NORTH AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066042438",
            "telephone_number": "203-335-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2157 NORTH AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066042438",
            "telephone_number": "203-335-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEFY",
        "first_name": "KIRK",
        "middle_name": "DENYS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-21",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.