Individual
MS. LEYLA AMANDA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., ED.M, L.P.C.
Contact information
Practice address
520 MAIN ST STE 204, FORT LEE, NJ 07024-4501
(201) 397-5662
Mailing address
520 MAIN ST STE 204, FORT LEE, NJ 07024-4501
(201) 397-5662
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00413800
NJ
Other
Enumeration date
07/17/2011
Last updated
07/17/2011
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