Provider Demographics
NPI:1104396811
Name:MARIN MATHEUS AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MARIN MATHEUS AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER VICEPRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEUS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, CPCS,RPT
Authorized Official - Phone:404-434-1267
Mailing Address - Street 1:2050 BEAUMONT LN
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 BEAUMONT LN
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4500
Practice Address - Country:US
Practice Address - Phone:404-434-1267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003200881AMedicaid