Provider Demographics
NPI:1154574127
Name:MATTIS, NOEMI PERELMAN (JD, PHD)
Entity type:Individual
Prefix:DR
First Name:NOEMI
Middle Name:PERELMAN
Last Name:MATTIS
Suffix:
Gender:F
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 FEDERAL HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4491
Mailing Address - Country:US
Mailing Address - Phone:801-363-4048
Mailing Address - Fax:801-322-4568
Practice Address - Street 1:299 FEDERAL HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-4491
Practice Address - Country:US
Practice Address - Phone:801-363-4048
Practice Address - Fax:801-322-4568
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110430-2501103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service