Provider Demographics
NPI:1912305855
Name:MATAMOROS, DULCE (MS, CMHP, PHD, BCBA,)
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:
Last Name:MATAMOROS
Suffix:
Gender:F
Credentials:MS, CMHP, PHD, BCBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15969 NW 64TH AVE
Mailing Address - Street 2:APT402
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5596
Mailing Address - Country:US
Mailing Address - Phone:786-429-1225
Mailing Address - Fax:305-602-5987
Practice Address - Street 1:12001 SW 128TH CT
Practice Address - Street 2:SUITE102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4664
Practice Address - Country:US
Practice Address - Phone:786-429-1225
Practice Address - Fax:305-602-5987
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst