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General NPI Number Information
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NPI Number | 1881594596
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Entity Type | Individual
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Provider Name | MS. IRENA MATA I
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Gender | Female
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Dates
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Enumeration Date | 11/07/2026
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Last Update Date | 11/07/2026
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Provider Practice Location Address
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Address Line | 2631 MERRICK RD STE 302
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City | BELLMORE
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State | NY
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Zip | 11710-5784
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Country | US
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Telephone | 516-535-9510
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Fax |
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Provider Business Mailing Address
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Address Line | 3603 168TH ST APT 4A
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City | FLUSHING
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State | NY
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Zip | 11358-2172
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Country | US
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Telephone | 347-951-6236
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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