Provider Demographics
NPI:1760243034
Name:MATTY, MARGARET MANDY
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MANDY
Last Name:MATTY
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 1:4719 READING RD APT 4114
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2153
Mailing Address - Country:US
Mailing Address - Phone:682-747-4472
Mailing Address - Fax:
Practice Address - Street 1:4719 READING RD APT 4114
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2153
Practice Address - Country:US
Practice Address - Phone:682-747-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-250160106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician