Provider Demographics
NPI:1699583666
Name:MATTEI, EDNA I (PHD)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:I
Last Name:MATTEI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1256
Mailing Address - Country:US
Mailing Address - Phone:787-360-2179
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE SOL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4881
Practice Address - Country:US
Practice Address - Phone:787-284-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical