Provider Demographics
NPI:1871397224
Name:CRECELIUS, MATHEW
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:CRECELIUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 IVY ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1710
Mailing Address - Country:US
Mailing Address - Phone:401-834-0876
Mailing Address - Fax:
Practice Address - Street 1:200 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2847
Practice Address - Country:US
Practice Address - Phone:401-365-6811
Practice Address - Fax:401-365-6813
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI201923101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)