Provider Demographics
NPI:1750835393
Name:MATLOCK, LUDMILLA
Entity Type:Individual
Prefix:
First Name:LUDMILLA
Middle Name:
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SARAH LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2774
Mailing Address - Country:US
Mailing Address - Phone:508-868-2043
Mailing Address - Fax:
Practice Address - Street 1:14 SARAH LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2774
Practice Address - Country:US
Practice Address - Phone:508-868-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst