Provider Demographics
NPI:1396568374
Name:SCHAFER, MATTHEW N
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
Last Name:SCHAFER
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 1:868 NW 90TH TER # 868
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1191
Mailing Address - Country:US
Mailing Address - Phone:954-955-7730
Mailing Address - Fax:
Practice Address - Street 1:868 NW 90TH TER # 868
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1191
Practice Address - Country:US
Practice Address - Phone:954-955-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-389762106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician