Provider Demographics
NPI:1821576620
Name:VERA MATEJIC LCSW, LLC
Entity Type:Organization
Organization Name:VERA MATEJIC LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEJIC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-331-8053
Mailing Address - Street 1:123 WHETHERBINE WAY W
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-8536
Mailing Address - Country:US
Mailing Address - Phone:305-331-8053
Mailing Address - Fax:
Practice Address - Street 1:1325 E TENNESSEE ST OFC 2
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5107
Practice Address - Country:US
Practice Address - Phone:305-331-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13325261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017060800Medicaid