Provider Demographics
NPI:1619016136
Name:MATTEI, ISA (LMHC)
Entity Type:Individual
Prefix:
First Name:ISA
Middle Name:
Last Name:MATTEI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8633
Mailing Address - Country:US
Mailing Address - Phone:617-997-1878
Mailing Address - Fax:781-648-6601
Practice Address - Street 1:89 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8633
Practice Address - Country:US
Practice Address - Phone:617-997-1878
Practice Address - Fax:781-648-6601
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5760OtherLICENSE NO
MALM1200OtherBCBS