Provider Demographics
NPI:1518571959
Name:MATE, JUDITH (LSWAIC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MATE
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:MATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSWAIC
Mailing Address - Street 1:11618 58TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9084
Mailing Address - Country:US
Mailing Address - Phone:314-398-2324
Mailing Address - Fax:
Practice Address - Street 1:1215 HIGHTOWER TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6244
Practice Address - Country:US
Practice Address - Phone:866-523-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057236535Medicaid