MEDICARE: EMILY MATA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-18-31745	MD

General Provider Information

NPI Number	:	1528594363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MATA

Provider Business Mailing Address
First Line	:	7120 SAMUEL MORSE DR STE 150
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3420
Country	:	US
Telephone Number	:	888-344-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	4840 MARIANNE DR
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4945
Country	:	US
Telephone Number	:	443-926-6881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	03/19/2026

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Directions to “ EMILY MATA ” Practice Location

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