| NPI | 1366672602 |
|---|---|
| Former Name | ANDREA MATA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 7323) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 9460) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2016-06-17 |