Provider Demographics
NPI:1295504686
Name:MATIAS, MELISSA B (CBHCM-P)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:MATIAS
Suffix:
Gender:F
Credentials:CBHCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26450 SW 146TH CT APT 202
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6531
Mailing Address - Country:US
Mailing Address - Phone:305-498-1244
Mailing Address - Fax:
Practice Address - Street 1:26450 SW 146TH CT APT 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6531
Practice Address - Country:US
Practice Address - Phone:305-498-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM320542996220171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator