Provider Demographics
NPI:1790256501
Name:FEDERICI, MATTHEW DARIN (MA, LMHC #17083)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DARIN
Last Name:FEDERICI
Suffix:
Gender:M
Credentials:MA, LMHC #17083
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 N US HIGHWAY 301 STE 1000
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-2208
Mailing Address - Country:US
Mailing Address - Phone:813-524-2001
Mailing Address - Fax:
Practice Address - Street 1:3012 N US HIGHWAY 301 STE 1000
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2208
Practice Address - Country:US
Practice Address - Phone:813-524-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC17083101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional