Provider Demographics
NPI:1104928951
Name:MATLACK, RHONDA C (MA LMHC)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:C
Last Name:MATLACK
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-1103
Mailing Address - Country:US
Mailing Address - Phone:978-270-5647
Mailing Address - Fax:
Practice Address - Street 1:14 CEDAR ST
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-1831
Practice Address - Country:US
Practice Address - Phone:978-270-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health