Provider Demographics
NPI:1942349303
Name:MATTIS MIER, KAREN (PSYD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MATTIS MIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 LIGHTHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1326
Mailing Address - Country:US
Mailing Address - Phone:954-385-3390
Mailing Address - Fax:954-316-7553
Practice Address - Street 1:624 W TROPICAL WAY
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3348
Practice Address - Country:US
Practice Address - Phone:954-584-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical