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Individual
THERESA MARIE MATOCHA
Active
Individual
THERESA MARIE MATOCHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISCW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
089.0089650
VT
1041C0700X
Clinical Social Worker
Primary
089.0089650
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089.0089650
STATE OF VT
VT
Enumeration date
12/27/2012
Last updated
11/10/2021
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