Individual
ZAIRA IVELISSE MATIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
(203) 756-8021
Mailing address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
(203) 756-8021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11111111
CASE MANAGER
CT
Enumeration date
08/17/2022
Last updated
08/17/2022
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