Provider Demographics
NPI:1235376013
Name:MATOS, MARIBEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE MARACAIBO
Mailing Address - Street 2:PARK GARDENS COURT 208
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2234
Mailing Address - Country:US
Mailing Address - Phone:787-755-5322
Mailing Address - Fax:
Practice Address - Street 1:381 CALLE ELEONOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2108
Practice Address - Country:US
Practice Address - Phone:787-505-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR633103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical