Provider Demographics
NPI:1548483886
Name:MATTIUZZO, LEONIE D (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEONIE
Middle Name:D
Last Name:MATTIUZZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 SW 14TH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-362-9303
Mailing Address - Fax:561-391-3092
Practice Address - Street 1:399 CAMINO GARDENS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-362-9303
Practice Address - Fax:561-391-3092
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW2518OtherLIC
FL6255762OtherUNITED HEALTHCARE