Provider Demographics
NPI:1922880343
Name:MATOS, LIZMARIE (MSW)
Entity Type:Individual
Prefix:
First Name:LIZMARIE
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 3991
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-7119
Mailing Address - Country:US
Mailing Address - Phone:787-237-1651
Mailing Address - Fax:
Practice Address - Street 1:CARR. 159 INT KM 19.3
Practice Address - Street 2:BO. QUEBRADA ARENAS SEC. LOS HOYOS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-237-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR161861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical