MEDICARE: GEORGIE DE MATTOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ASW116140	CA

General Provider Information

NPI Number	:	1285413252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIE DE MATTOS

Provider Business Mailing Address
First Line	:	6247 MELBA AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-1520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6247 MELBA AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-1520
Country	:	US
Telephone Number	:	818-731-0363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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Directions to “ GEORGIE DE MATTOS ” Practice Location

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