Provider Demographics
NPI:1699954669
Name:MATOS, MARTA N (PSYD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:N
Last Name:MATOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 SW 92ND ST
Mailing Address - Street 2:B-8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-598-8879
Mailing Address - Fax:305-598-0220
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:B-8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-598-8879
Practice Address - Fax:305-598-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54756OtherBLUECROSS BLUESHIELD PIN
FLE5311Medicare PIN
FLE5311Medicare UPIN