Doctor Name: | MS. VILMA E, MATOS |
NPI Number: | 1265896831 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-R |
License Number: | 946435991 |
Business Practice Address: | 39 Georgia St East Northport, NY - 117312232 |
Business Phone Number: | 6318072822 |
Business Fax Number: | 6312620823 |
Mailing Address: | 39 Georgia St, EAST NORTHPORT |
State: | NY |
Postal Code: | 117312232 |
Phone Number: | 6318072822 |
Fax Number: | 6312620823 |
NPI Enumeration Date: | 04/11/2016 |
NPI Last Update Date: | 04/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | 946435991 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |