Provider Demographics
NPI:1801657499
Name:MATOS, JAILYN
Entity type:Individual
Prefix:
First Name:JAILYN
Middle Name:
Last Name:MATOS
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 1:659 PROSPECT ST APT C3
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-7003
Mailing Address - Country:US
Mailing Address - Phone:413-378-5765
Mailing Address - Fax:
Practice Address - Street 1:659 PROSPECT ST APT C3
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-7003
Practice Address - Country:US
Practice Address - Phone:413-378-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician