Provider Demographics
NPI:1700411154
Name:MATYCHAK, REINA
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:MATYCHAK
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 1:4094 SW 168TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-6708
Mailing Address - Country:US
Mailing Address - Phone:352-843-6737
Mailing Address - Fax:
Practice Address - Street 1:2440 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HILLS
Practice Address - State:FL
Practice Address - Zip Code:34442-5320
Practice Address - Country:US
Practice Address - Phone:352-558-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25113101YM0800X
FLPN5174665164W00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse