Provider Demographics
NPI:1316624364
Name:MATIAS, TALIA ANNEMARIE
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:ANNEMARIE
Last Name:MATIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 BRAYLON ST APT 105
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9749
Mailing Address - Country:US
Mailing Address - Phone:651-219-8265
Mailing Address - Fax:
Practice Address - Street 1:5685 BRAYLON ST
Practice Address - Street 2:APT 105
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:651-219-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health