Individual
MISS DIANE MATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
640 CENTRE ST, JAMAICA PLAIN, MA 02130-2555
(617) 983-4224
Mailing address
28 WYETH ST, MALDEN, MA 02148-5620
(617) 983-4224
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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