Provider Demographics
NPI:1700406204
Name:BEISSO, MATILDE (LCPC)
Entity type:Individual
Prefix:
First Name:MATILDE
Middle Name:
Last Name:BEISSO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3442
Mailing Address - Country:US
Mailing Address - Phone:301-783-3655
Mailing Address - Fax:
Practice Address - Street 1:8 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3442
Practice Address - Country:US
Practice Address - Phone:301-783-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2025-09-02
Deactivation Date:2021-07-02
Deactivation Code:
Reactivation Date:2025-08-27
Provider Licenses
StateLicense IDTaxonomies
MDLC16129101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty