Individual
GINA M MATOS-KARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
998 CROOKED HILL RD, BRENTWOOD, NY 11717-1019
(631) 306-5714
Mailing address
260 CORONADO ST, ISLIP TERRACE, NY 11752-1712
(631) 650-7022
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10786
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02249145
—
NY
Enumeration date
10/21/2008
Last updated
10/21/2008
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