Provider Demographics
NPI:1801307079
Name:MATARA SERVICES LLC
Entity type:Organization
Organization Name:MATARA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARNAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-800-1590
Mailing Address - Street 1:248 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4831
Mailing Address - Country:US
Mailing Address - Phone:732-800-1590
Mailing Address - Fax:
Practice Address - Street 1:248 PINE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4831
Practice Address - Country:US
Practice Address - Phone:732-800-1590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26225103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty