Provider Demographics
NPI:1295223071
Name:MATTIS, DEIDRE ALEXANDRIA (BS)
Entity Type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:ALEXANDRIA
Last Name:MATTIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1132 SW AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4267
Mailing Address - Country:US
Mailing Address - Phone:561-257-8393
Mailing Address - Fax:561-557-6711
Practice Address - Street 1:5305 GREENWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2448
Practice Address - Country:US
Practice Address - Phone:561-257-8393
Practice Address - Fax:561-557-6711
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker