Provider Demographics
NPI:1598193518
Name:MATARELLI, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MATARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLAND
Other - Middle Name:
Other - Last Name:MATARELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 WEST AVE
Mailing Address - Street 2:APT 1111
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5233
Mailing Address - Country:US
Mailing Address - Phone:786-603-0442
Mailing Address - Fax:
Practice Address - Street 1:900 WEST AVE
Practice Address - Street 2:APT 1111
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5233
Practice Address - Country:US
Practice Address - Phone:786-603-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM364014839680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst