Healthcare Provider Details

I. General information

NPI: 1245124387
Provider Name (Legal Business Name): JANESE MATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

IV. Provider business mailing address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-1458
  • Fax:
Mailing address:
  • Phone: 301-604-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP16706
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: