Healthcare Provider Details

I. General information

NPI: 1679561146
Provider Name (Legal Business Name): MARTA N MATOS PSYD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 SW 92ND ST #B-8
MIAMI FL
33156-7365
US

IV. Provider business mailing address

8525 SW 92ND ST #B-8
MIAMI FL
33156-7365
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-8879
  • Fax: 305-598-0220
Mailing address:
  • Phone: 305-598-8879
  • Fax: 305-598-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6307
License Number StateFL

VIII. Authorized Official

Name: MS. MARTA NILDA MATOS
Title or Position: OWNER
Credential: PSYD
Phone: 305-598-8879