Healthcare Provider Details

I. General information

NPI: 1609608702
Provider Name (Legal Business Name): PEDRO ENRIQUE POOT MATU BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EDGEWATER PL STE 100
WAKEFIELD MA
01880-1281
US

IV. Provider business mailing address

8910 SW 150TH COURT CIR N
MIAMI FL
33196-1332
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 784-746-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45189
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: