Provider Demographics
NPI:1700411154
Name:MATYCHAK, REINA
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:MATYCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 SW 111TH PLACE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-7749
Mailing Address - Country:US
Mailing Address - Phone:352-843-6737
Mailing Address - Fax:
Practice Address - Street 1:110 S APOPKA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4837
Practice Address - Country:US
Practice Address - Phone:352-560-7027
Practice Address - Fax:352-877-4162
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No252Y00000XAgenciesEarly Intervention Provider Agency