Healthcare Provider Details

I. General information

NPI: 1164156808
Provider Name (Legal Business Name): MATTHEW ERWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2022
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH AVE FL 3
MIAMI FL
33136-1104
US

IV. Provider business mailing address

631 NE 10TH AVE APT 4
FORT LAUDERDALE FL
33304-5002
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax:
Mailing address:
  • Phone: 774-219-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: