Provider Demographics
NPI:1548876352
Name:MATA, SYDNEE LEE (MSW)
Entity type:Individual
Prefix:MS
First Name:SYDNEE
Middle Name:LEE
Last Name:MATA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SYDNEE
Other - Middle Name:LEE
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SYDNEE L MATA, MSW
Mailing Address - Street 1:480 WINDCROFT CIR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3786
Mailing Address - Country:US
Mailing Address - Phone:404-521-6266
Mailing Address - Fax:
Practice Address - Street 1:480 WINDCROFT CIR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3786
Practice Address - Country:US
Practice Address - Phone:404-521-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty