Provider Demographics
NPI:1447842703
Name:MATOS - MARTINEZ, INGRID M (BA)
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:M
Last Name:MATOS - MARTINEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:INGRID
Other - Middle Name:M
Other - Last Name:MATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2536 AVENTURINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-7207
Mailing Address - Country:US
Mailing Address - Phone:407-922-4836
Mailing Address - Fax:
Practice Address - Street 1:2536 AVENTURINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-7207
Practice Address - Country:US
Practice Address - Phone:407-922-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor