Healthcare Provider Details

I. General information

NPI: 1508779471
Provider Name (Legal Business Name): NIKOL DENISSE MATOS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #5 AVE. CENTRAL JUANITA FINAL
BAYAMON PR
00960
US

IV. Provider business mailing address

PALACIOS DEL MONTE 1574 CALLE MAKALU E15
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 939-225-2400
  • Fax:
Mailing address:
  • Phone: 787-242-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13545
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: