Provider Demographics
NPI:1326192394
Name:MATA, JOSEFINA (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2214 NORTHGATE CIR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-3826
Mailing Address - Country:US
Mailing Address - Phone:956-447-9262
Mailing Address - Fax:
Practice Address - Street 1:2101 S COL ROWE BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1272
Practice Address - Country:US
Practice Address - Phone:956-618-7105
Practice Address - Fax:956-618-7122
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical