Individual ProviderCarmen MataCounselorBehavioral Health & Social Service ProvidersPractice Address520 Dudley St, Roxbury, MA 02119-2769(617) 516-5733PECOS EnrollmentBased on the most recent information from CMS, provider Carmen Mata does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1053768572Provider TypeIndividualFull NameMata, CarmenGenderFemaleSole ProprietorYesEnumeration Date5/16/2016Last Updated5/16/2016Contact InformationPractice LocationPractice Address520 Dudley St, Roxbury, MA 02119-2769Phone(617) 516-5733FaxUnlisted FaxMailing LocationMailing Address520 Dudley St, Roxbury, MA 02119-2769Phone(617) 516-5733FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID100009651281DescriptionOtherIssuerNEIGHBORHOOD HEALTH PLANMassachusetts