Provider Demographics
NPI:1205234317
Name:SARA MATOS
Entity type:Organization
Organization Name:SARA MATOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:347-721-1527
Mailing Address - Street 1:6415 E LOWDEN ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-9110
Mailing Address - Country:US
Mailing Address - Phone:347-721-1527
Mailing Address - Fax:
Practice Address - Street 1:711 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5343
Practice Address - Country:US
Practice Address - Phone:347-721-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-06
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health