Provider Demographics
NPI:1710208749
Name:MATA, REBECA ELVIRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:ELVIRA
Last Name:MATA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9504 IH35 N
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6613
Mailing Address - Country:US
Mailing Address - Phone:210-650-0422
Mailing Address - Fax:210-650-0169
Practice Address - Street 1:9504 IH35 N
Practice Address - Street 2:SUITE 214
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6613
Practice Address - Country:US
Practice Address - Phone:210-650-0422
Practice Address - Fax:210-650-0169
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical