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General NPI Number Information
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NPI Number | 1770093999
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Entity Type | Individual
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Provider Name | LUIS R MATOS LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 8808 LIBERTY AVE
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City | OZONE PARK
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State | NY
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Zip | 11417-1329
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Country | US
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Telephone | 952-949-9342
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Fax |
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Provider Business Mailing Address
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Address Line | 8768 114TH ST
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2438
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Country | US
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Telephone | 929-499-3420
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 070486
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License Number State | NY
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