Healthcare Provider Details

I. General information

NPI: 1093694671
Provider Name (Legal Business Name): MATITA MARTIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 BISCAYNE BLVD
NORTH MIAMI FL
33181-2743
US

IV. Provider business mailing address

4371 LYNX PAW TRL
VALRICO FL
33596-7426
US

V. Phone/Fax

Practice location:
  • Phone: 813-906-6296
  • Fax:
Mailing address:
  • Phone: 813-657-2100
  • Fax: 813-354-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: