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Individual

MR. JUAN C MATEO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP

Contact information

Practice address
123 ANDOVER RD, WESTBROOK, ME 04092-3850
(207) 761-2200
Mailing address
3 FOREST CIR APT 1, PORTLAND, ME 04103-1333
(718) 913-8899

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
CNP191299
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1340368
DRIVER'S LICENSE
ME
Enumeration date
12/13/2019
Last updated
12/13/2019
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