Individual
VICKIE E MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 WILLOW ST, LYNN, MA 01901-1139
(781) 581-6600
(781) 581-2209
Mailing address
100 WILLOW ST, LYNN, MA 01901-1139
(781) 581-6600
(781) 581-2209
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171M00000X
—
MA
Enumeration date
01/31/2019
Last updated
01/31/2019
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