Provider Demographics
NPI:1750659769
Name:BARBOSA, MATEUS J (MS)
Entity Type:Individual
Prefix:
First Name:MATEUS
Middle Name:J
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1650
Mailing Address - Country:US
Mailing Address - Phone:617-523-6400
Mailing Address - Fax:617-523-3034
Practice Address - Street 1:31 HEATH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1650
Practice Address - Country:US
Practice Address - Phone:617-523-6400
Practice Address - Fax:617-523-3034
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid