Provider Demographics
NPI:1396240644
Name:MATEO, EDELIN C
Entity type:Individual
Prefix:
First Name:EDELIN
Middle Name:C
Last Name:MATEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 E 168TH ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3855
Mailing Address - Country:US
Mailing Address - Phone:401-523-0852
Mailing Address - Fax:
Practice Address - Street 1:747 E 168TH ST APT 3E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3855
Practice Address - Country:US
Practice Address - Phone:401-523-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool