Provider Demographics
NPI:1376688788
Name:ROSEN, MATTHEW NATHAN (MS, LMHC, NCC, PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:NATHAN
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MS, LMHC, NCC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NE 20TH ST
Mailing Address - Street 2:APT. 902
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2105
Mailing Address - Country:US
Mailing Address - Phone:954-540-4332
Mailing Address - Fax:
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:SUITE 307
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:954-540-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health