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General NPI Number Information
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NPI Number | 1003070665
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Entity Type | Individual
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Provider Name | MATTI ILMARI KALA LMSW
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Gender | Male
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 22005 JAMAICA AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-2140
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Country | US
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Telephone | 718-740-5000
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Fax | 718-479-0200
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Provider Business Mailing Address
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Address Line | 7001 113TH ST APT. 7F
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City | FOREST HILLS
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State | NY
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Zip | 11375-4656
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Country | US
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Telephone | 718-793-0304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 074105-1
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License Number State | NY
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