Provider Demographics
NPI:1487978672
Name:MATOS, PAULA ALEXANDRA (MA, BCABA)
Entity type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:ALEXANDRA
Last Name:MATOS
Suffix:
Gender:F
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 GORHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3178
Mailing Address - Country:US
Mailing Address - Phone:407-516-9171
Mailing Address - Fax:
Practice Address - Street 1:4809 GORHAM AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3178
Practice Address - Country:US
Practice Address - Phone:407-516-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-09-3683103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst