Provider Demographics
NPI:1396487039
Name:MATOS, SOFIA (RBT)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10825 TILSTON PT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6148
Mailing Address - Country:US
Mailing Address - Phone:407-963-3304
Mailing Address - Fax:
Practice Address - Street 1:2065 AMBERGRIS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8336
Practice Address - Country:US
Practice Address - Phone:689-837-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician