Provider Demographics
NPI:1609608702
Name:POOT MATU, PEDRO ENRIQUE (BCBA)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ENRIQUE
Last Name:POOT MATU
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 SW 150TH COURT CIR N
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1332
Mailing Address - Country:US
Mailing Address - Phone:784-746-6104
Mailing Address - Fax:
Practice Address - Street 1:8910 SW 150TH COURT CIR N
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1332
Practice Address - Country:US
Practice Address - Phone:784-746-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-45189103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty