Provider Demographics
NPI:1285057661
Name:MATA, MABEL SALVATIERRA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:SALVATIERRA
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 1:1901 ELSINORE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1619
Mailing Address - Country:US
Mailing Address - Phone:951-892-8198
Mailing Address - Fax:
Practice Address - Street 1:8520 ARCHIBALD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4648
Practice Address - Country:US
Practice Address - Phone:951-892-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical