Provider Demographics
NPI:1275946139
Name:MATOS FRADERA, NILMARIE (PSICOLOGA)
Entity Type:Individual
Prefix:DR
First Name:NILMARIE
Middle Name:
Last Name:MATOS FRADERA
Suffix:
Gender:F
Credentials:PSICOLOGA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA BLANCA
Mailing Address - Street 2:CALLE ACERINA 2
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-900-3983
Mailing Address - Fax:
Practice Address - Street 1:VILLA BLANCA
Practice Address - Street 2:CALLE ACERINA 2
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-900-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5223103TA0700X, 103TC1900X, 103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities