Provider Demographics
NPI:1346130879
Name:PARRA, MATTHEW ANDRES
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANDRES
Last Name:PARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SW 57TH AVE STE 313
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:786-404-1017
Mailing Address - Fax:
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:786-404-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician