Marissa Anne Mata

NPI #1134611981 in Mchenry, Illinois

Provider Information

NPI Number: 1134611981
Entity Type: Individual
Name: Marissa Anne Mata
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Social Worker
Enumeration Date: Jun 6, 2018
Last Updated: Jun 6, 2018

Practice Location

Address: 4031 W DAYTON ST
City: Mchenry
State: Illinois
ZIP Code: 60050-8377
Phone: (815) 344-1230

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker	104100000X	Primary

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