Staley, Matthew

Staley, Matthew is an individual health care provider with primary practice located at 25480 W Cedar Crest Ln , Lake Villa IL 60046-9744. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Staley, Matthew can be contacted via phone (847) 356-8205.

Contact Information

Primary practice address
25480 W Cedar Crest Ln Lake Villa IL 60046-9744
Phone: (847) 356-8205
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149021089 Illinois

Profile Details

NPI number 1770123671
LBN Legal business name Staley, Matthew
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2020
Last updated Jan 9th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770123671 NPPES
Illinois Other 149021089 STATE OF ILLINOIS

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