Provider Demographics
NPI:1871154633
Name:PULIATTI, MATTHEW RICHARD (LMHC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RICHARD
Last Name:PULIATTI
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:212-570-1693
Mailing Address - Fax:
Practice Address - Street 1:251 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4067
Practice Address - Country:US
Practice Address - Phone:212-570-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008927OtherLICENSED MENTAL HEALTH COUNSELOR