Active NPI
Matthew Charles Pittman Purinton, LCSW
- Mental Health Counselor
- Philadelphia, PA
National Provider Identifier
1700255163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CW018087
- Practice address
- 4025 Chestnut Street
First Floor, Council for Relationships
Philadelphia, PA 19104 - Phone
- (215) 382-6680
- Fax
- (215) 386-1743
- NPI assigned
- Sep 16, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CW018087 | PA | Primary |
Addresses
Primary practice location
4025 Chestnut Street
First Floor, Council for Relationships
Philadelphia, PA 19104
Mailing address
4025 Chestnut Street
First Floor, Council for Relationships
Philadelphia, PA 19104
Phone (215) 382-6680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 2, 2024 through Jun 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CW018087 | PA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442361600000",
"number": "1700255163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4025 CHESTNUT STREET",
"address_2": "FIRST FLOOR, COUNCIL FOR RELATIONSHIPS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-382-6680",
"fax_number": "215-386-1743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4025 CHESTNUT STREET",
"address_2": "FIRST FLOOR, COUNCIL FOR RELATIONSHIPS",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "215-382-6680",
"fax_number": "215-386-1743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURINTON",
"first_name": "MATTHEW",
"middle_name": "CHARLES PITTMAN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2015-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": "CW018087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.