Provider Demographics
NPI:1336862705
Name:MATEO, LUIS ANGEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:MATEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 CHICOPEE ST APT 21
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1766
Mailing Address - Country:US
Mailing Address - Phone:787-307-4133
Mailing Address - Fax:
Practice Address - Street 1:269 CHICOPEE ST APT 21
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1766
Practice Address - Country:US
Practice Address - Phone:787-307-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty