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NPI Code Detail

MEDICARE: MR. JEOVANI MATA LMSW

MEDICARE: MR. JEOVANI MATA LMSW
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
1104100000XSocial Worker115915NY

General Provider Information

NPI Number : 1386385524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEOVANI MATA LMSW
Provider Business Mailing Address
First Line : 299 E 161ST ST APT 703
Second Line :
City : BRONX
State : NY
Zip : 10451-2686
Country : US
Telephone Number : 718-820-6153
Fax Number :
Provider Business Practice Location Address
First Line : 356 W 18TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10011-4401
Country : US
Telephone Number : 212-271-7200
Fax Number : 212-271-8116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2022
Last Update Date : 04/23/2025

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Directions to “ MR. JEOVANI MATA LMSW” Practice Location

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