MEDICARE: MRS. ANGELA M MATOS DT

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
1	103T00000X	Psychologist		SC

General Provider Information

NPI Number	:	1902736697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA M MATOS DT

Provider Business Mailing Address
First Line	:	561 RED WOLF LN
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-6728
Country	:	US
Telephone Number	:	704-307-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 RED WOLF LN
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-6728
Country	:	US
Telephone Number	:	704-307-6127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ MRS. ANGELA M MATOS DT” Practice Location

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