Provider Demographics
NPI:1497992481
Name:PETJE, MATEJA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MATEJA
Middle Name:
Last Name:PETJE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MRS
Other - First Name:MATEJA
Other - Middle Name:
Other - Last Name:VARON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:6175 NW 153RD ST
Mailing Address - Street 2:STE 404
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2435
Mailing Address - Country:US
Mailing Address - Phone:305-558-7400
Mailing Address - Fax:305-558-6174
Practice Address - Street 1:6175 NW 153RD ST
Practice Address - Street 2:STE 404
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2435
Practice Address - Country:US
Practice Address - Phone:305-558-7400
Practice Address - Fax:305-558-6174
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist