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NPI Code Detail

MEDICARE: MATHEW JEAN LMFT

MEDICARE:   MATHEW  JEAN  LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMT 3034FL

General Provider Information

NPI Number : 1245610070
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATHEW JEAN LMFT
Provider Business Mailing Address
First Line : 9660 ROYAL PALM BLVD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33065-4991
Country : US
Telephone Number : 305-522-5105
Fax Number :
Provider Business Practice Location Address
First Line : 9660 ROYAL PALM BLVD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33065-4991
Country : US
Telephone Number : 305-522-5105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2015
Last Update Date : 06/06/2015

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