Provider Demographics
NPI:1225484470
Name:MATA, SOLANGEL (BSW,CASAC T)
Entity Type:Individual
Prefix:
First Name:SOLANGEL
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:BSW,CASAC T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3402
Mailing Address - Country:US
Mailing Address - Phone:914-964-7374
Mailing Address - Fax:914-964-7720
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3402
Practice Address - Country:US
Practice Address - Phone:914-964-7374
Practice Address - Fax:914-964-7720
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health