Provider Demographics
NPI:1821019647
Name:MATOS, MAYRA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16357 SW 48TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4694
Mailing Address - Country:US
Mailing Address - Phone:954-558-0473
Mailing Address - Fax:
Practice Address - Street 1:17801 NW 2ND AVE
Practice Address - Street 2:205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-5029
Practice Address - Country:US
Practice Address - Phone:954-558-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical