Organization
MIRTA MATOS PSYD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRTA MATOS PSYD (OWNER)
(305) 596-9989
Entity
Organization
Contact information
Practice address
8525 SW 92ND ST, #B-8, MIAMI, FL 33156-7365
(305) 596-9989
(305) 598-0220
Mailing address
8525 SW 92ND ST, #B-8, MIAMI, FL 33156-7365
(305) 596-9989
(305) 598-0220
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6454
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54791
BCBS
FL
Enumeration date
10/10/2005
Last updated
08/22/2020
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