Healthcare Provider Details

I. General information

NPI: 1740980580
Provider Name (Legal Business Name): CYNTHIA MATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PLEASANT ST # 1211
MALDEN MA
02148-4904
US

IV. Provider business mailing address

51 PLEASANT ST # 1211
MALDEN MA
02148-4904
US

V. Phone/Fax

Practice location:
  • Phone: 978-219-4986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: