Healthcare Provider Details

I. General information

NPI: 1801384698
Provider Name (Legal Business Name): GINA MATTEI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 PORT SYLVANIA DR
TOLEDO OH
43617-1176
US

IV. Provider business mailing address

6629 W CENTRAL AVE
TOLEDO OH
43617-1098
US

V. Phone/Fax

Practice location:
  • Phone: 567-455-6081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: