Provider Demographics
NPI:1730432642
Name:MATHEW, REJI P (SOCIAL WORKER (LCSW))
Entity type:Individual
Prefix:MR
First Name:REJI
Middle Name:P
Last Name:MATHEW
Suffix:
Gender:M
Credentials:SOCIAL WORKER (LCSW)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 HAWKES BLUFF AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3416
Mailing Address - Country:US
Mailing Address - Phone:954-673-8958
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:786-299-3632
Practice Address - Fax:305-575-3164
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 51051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical