Provider Demographics
NPI:1649905167
Name:CAVAZOS, MATTHEW RAMIRO
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RAMIRO
Last Name:CAVAZOS
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 1:3185 BOUTWELL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2610
Mailing Address - Country:US
Mailing Address - Phone:561-533-0074
Mailing Address - Fax:561-533-8077
Practice Address - Street 1:3185 BOUTWELL RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-2610
Practice Address - Country:US
Practice Address - Phone:561-533-0074
Practice Address - Fax:561-533-8077
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)