NPIMap

Individual provider Active NPI

Dominique Mathurin

  • Mental Health Counselor
  • Orlando, FL
National Provider Identifier
1033397807
Registry record updated Aug 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
2167 Lake Debra Dr
Unit 738
Orlando, FL 32835-6616
Phone
(407) 403-8145
NPI assigned
Feb 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X
Community Health Worker 172V00000X
Mental Health Counselor 101YM0800X Primary
Social Worker 104100000X

Addresses

Primary practice location

2167 Lake Debra Dr
Unit 738
Orlando, FL 32835-6616

Mailing address

2167 Lake Debra Dr.
Unit 738
Orlando, FL 32835
Phone (407) 403-8145

Other identifiers 1

IdentifierTypeStateIssuer
010838900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wraparound Floridda Current Accepting new patients
247 Healthcare Agency Current Accepting new patients
Interfaith Humanitarian Services Inc Current Accepting new patients
Family Advocates Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1033397807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2167 LAKE DEBRA DR.",
            "address_2": "UNIT 738",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "32835",
            "telephone_number": "407-403-8145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2167 LAKE DEBRA DR",
            "address_2": "UNIT 738",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328356616",
            "telephone_number": "407-403-8145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHURIN",
        "first_name": "DOMINIQUE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-04",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010838900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.