Healthcare Provider Details

I. General information

NPI: 1437423845
Provider Name (Legal Business Name): LISA MATAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 W MARKET ST
WARREN OH
44485-3069
US

IV. Provider business mailing address

535 MARMION AVE
YOUNGSTOWN OH
44502-2323
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-6992
  • Fax:
Mailing address:
  • Phone: 330-782-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0900287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: