Provider Demographics
NPI:1902223670
Name:MATEO, MAXIEL AMAREYIS (LMFT, RN)
Entity Type:Individual
Prefix:
First Name:MAXIEL
Middle Name:AMAREYIS
Last Name:MATEO
Suffix:
Gender:F
Credentials:LMFT, RN
Other - Prefix:
Other - First Name:MAXIEL
Other - Middle Name:AMAREYIS
Other - Last Name:MATEO-FOXX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1117 SW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5770
Mailing Address - Country:US
Mailing Address - Phone:786-663-3265
Mailing Address - Fax:
Practice Address - Street 1:1117 SW 123RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5770
Practice Address - Country:US
Practice Address - Phone:786-663-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9648954163W00000X
FLMT4630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse