Provider Demographics
NPI:1164029153
Name:MATOS, MARIA J
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:J
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 1:20 E BROOKLINE ST APT 73
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4309
Mailing Address - Country:US
Mailing Address - Phone:617-482-5730
Mailing Address - Fax:
Practice Address - Street 1:20 E BROOKLINE ST APT 73
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4309
Practice Address - Country:US
Practice Address - Phone:617-482-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-03
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker