Healthcare Provider Details

I. General information

NPI: 1346889987
Provider Name (Legal Business Name): ESTHER MATA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 400 BOX 8443
APO AP
96273-0085
US

IV. Provider business mailing address

BUILDING 290 NORTH LOOP RD
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 702-498-0144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9905-C
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: