Provider Demographics
NPI:1780491738
Name:MATIAS, BRENDAN J
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:J
Last Name:MATIAS
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 1:2282 W 74TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6840
Mailing Address - Country:US
Mailing Address - Phone:786-491-8003
Mailing Address - Fax:
Practice Address - Street 1:2282 W 74TH ST APT 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6840
Practice Address - Country:US
Practice Address - Phone:786-491-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician