Provider Demographics
NPI:1730529272
Name:MATUTE, FRIDA INDIANA (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:FRIDA
Middle Name:INDIANA
Last Name:MATUTE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FIFTH AVENUE
Mailing Address - Street 2:SUITE 521
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5012
Mailing Address - Country:US
Mailing Address - Phone:917-960-3730
Mailing Address - Fax:888-807-7794
Practice Address - Street 1:246 5TH AVE
Practice Address - Street 2:SUITE 521
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7603
Practice Address - Country:US
Practice Address - Phone:917-960-3730
Practice Address - Fax:888-807-7794
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021181-1235Z00000X
NY12150081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist