Provider Demographics
NPI:1386250504
Name:MATTHEWS, LILLIAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 NE 191ST ST
Mailing Address - Street 2:PMB 904653
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179
Mailing Address - Country:US
Mailing Address - Phone:786-946-8966
Mailing Address - Fax:786-796-6417
Practice Address - Street 1:382 NE 191ST ST
Practice Address - Street 2:PMB 904653
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:786-946-8966
Practice Address - Fax:786-796-6417
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015516363LP0808X
FLRN9612463363LP0808X
FLAPRN11022597363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health