Individual
MR. CHRISTOPHER MATTIMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
3251 ROUTE 112, BLDG. 9, STE. 2, MEDFORD, NY 11763-1446
(631) 451-6007
(631) 297-8121
Mailing address
10 W 21ST ST, DEER PARK, NY 11729-3918
(631) 949-1257
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23778
NY
Other
Enumeration date
01/31/2014
Last updated
02/07/2014
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