Provider Demographics
NPI:1437797933
Name:MATA, EVELINA (SW)
Entity Type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1022
Mailing Address - Country:US
Mailing Address - Phone:646-675-9969
Mailing Address - Fax:
Practice Address - Street 1:73 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1022
Practice Address - Country:US
Practice Address - Phone:646-675-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker