Provider Demographics
NPI:1023439973
Name:MATIAS, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:MATIAS
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 1:620 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2972
Mailing Address - Country:US
Mailing Address - Phone:973-890-5888
Mailing Address - Fax:973-890-2755
Practice Address - Street 1:120 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1158
Practice Address - Country:US
Practice Address - Phone:973-890-5888
Practice Address - Fax:973-890-2755
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW01129400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker