Provider Demographics
NPI:1497944276
Name:MATT, JOAN C (MFT34941)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:C
Last Name:MATT
Suffix:
Gender:F
Credentials:MFT34941
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PINOT CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1854
Mailing Address - Country:US
Mailing Address - Phone:408-244-1834
Mailing Address - Fax:408-244-5123
Practice Address - Street 1:210 PINOT CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1854
Practice Address - Country:US
Practice Address - Phone:408-244-1834
Practice Address - Fax:408-244-5123
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist