Provider Demographics
NPI:1114162302
Name:MATOS, CARLOS MANUEL (MSED)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:MANUEL
Last Name:MATOS
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 MANNING ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5001
Mailing Address - Country:US
Mailing Address - Phone:646-220-9043
Mailing Address - Fax:
Practice Address - Street 1:2217 MANNING ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5001
Practice Address - Country:US
Practice Address - Phone:646-220-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst