Provider Demographics
NPI:1275964256
Name:MATTA, STEVEN (MS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:MATTA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STATION LNDG UNIT 405
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5179
Mailing Address - Country:US
Mailing Address - Phone:978-578-9051
Mailing Address - Fax:
Practice Address - Street 1:710 COTTON GIN ALY
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9324
Practice Address - Country:US
Practice Address - Phone:978-989-5543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst