Healthcare Provider Details

I. General information

NPI: 1003142167
Provider Name (Legal Business Name): MATHIEU KAMBURIAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 SW 9TH AVE
BOCA RATON FL
33486-5430
US

IV. Provider business mailing address

1322 SW 9TH AVE
BOCA RATON FL
33486-5430
US

V. Phone/Fax

Practice location:
  • Phone: 561-716-8648
  • Fax:
Mailing address:
  • Phone: 561-716-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7997
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21733
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: