Provider Demographics
NPI:1730989872
Name:MATEO DE ACOSTA, ODETTE
Entity type:Individual
Prefix:
First Name:ODETTE
Middle Name:
Last Name:MATEO DE ACOSTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 NE 14TH ST APT 1708
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1466
Mailing Address - Country:US
Mailing Address - Phone:305-542-7657
Mailing Address - Fax:
Practice Address - Street 1:58 NE 14TH ST APT 1708
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1466
Practice Address - Country:US
Practice Address - Phone:305-542-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-404186106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst