Provider Information for 1417287996
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KALISHA CORITA MATTERSON MSW
Sex: Female
NPI: 1417287996
Last Updated: 2010-01-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1417287996 | ||||||||||||
| Enumeration Date | 2010-01-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 11031 NE 6TH AVE MIAMI, FL 33161-7182 United States Phone: 305-398-6100 | Fax:305-757-4465 | ||||||||||||
| Primary Practice Address | 140 NW 59TH ST MIAMI, FL 33127-1218 United States Phone: 305-759-8888 | Fax:305-757-5989 | ||||||||||||
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