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General NPI Number Information
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NPI Number | 1730432642
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Entity Type | Individual
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Provider Name | REJI P MATHEW SOCIAL WORKER (LCSW)
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Gender | Male
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 1201 NW 16TH ST
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City | MIAMI
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State | FL
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Zip | 33125-1624
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Country | US
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Telephone | 786-299-3632
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Fax | 305-575-3164
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Provider Business Mailing Address
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Address Line | 6120 HAWKES BLUFF AVE
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City | DAVIE
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State | FL
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Zip | 33331-3416
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Country | US
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Telephone | 954-673-8958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 5105
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License Number State | FL
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