Provider Demographics
NPI:1801668132
Name:SANG-MATA, ADA KUEILAN (MSW, LSW)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:KUEILAN
Last Name:SANG-MATA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MYRTLE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3297
Mailing Address - Country:US
Mailing Address - Phone:862-394-7800
Mailing Address - Fax:
Practice Address - Street 1:170 MYRTLE AVE APT 3
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3297
Practice Address - Country:US
Practice Address - Phone:862-394-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06708100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker