Individual
CARMEN MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 516-5733
Mailing address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 516-5733
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100009651281
NEIGHBORHOOD HEALTH PLAN
MA
Enumeration date
05/16/2016
Last updated
05/16/2016
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