Provider Demographics
NPI:1932488657
Name:MATTER-DANG, AGNES EDITH
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:EDITH
Last Name:MATTER-DANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:EDITH
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 SADDLE RACK ST
Mailing Address - Street 2:# 402
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3498
Mailing Address - Country:US
Mailing Address - Phone:650-799-2585
Mailing Address - Fax:
Practice Address - Street 1:1245 E SANTA CLARA ST
Practice Address - Street 2:ALUM ROCK COUNSELING CENTER
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2337
Practice Address - Country:US
Practice Address - Phone:408-294-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor