Healthcare Provider Details

I. General information

NPI: 1619896560
Provider Name (Legal Business Name): MISS ALEXA NICOLE MATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 CHURCH ST
NEW BEDFORD MA
02745-1400
US

IV. Provider business mailing address

143 MILL ST
NEW BEDFORD MA
02740-5136
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-8752
  • Fax:
Mailing address:
  • Phone: 508-405-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: