Provider Demographics
NPI:1336787951
Name:MATEO, JUAN C (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:C
Last Name:MATEO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:C
Other - Last Name:MATEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3 FOREST CIR APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1333
Mailing Address - Country:US
Mailing Address - Phone:718-913-8899
Mailing Address - Fax:
Practice Address - Street 1:123 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3850
Practice Address - Country:US
Practice Address - Phone:207-761-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP1912992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1340368OtherDRIVER'S LICENSE