Individual
JACQUELINE MATACCHIERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 BOULEVARD STE 101, MOUNTAIN LAKES, NJ 07046-1733
(973) 988-0035
Mailing address
40 GATES PL, WAYNE, NJ 07470-3217
(201) 724-1190
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00279900
NJ
101YP2500X
Professional Counselor
Primary
37PC00585900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
DO SERVE MEDICAID CLIENTS AS OF YET
—
Enumeration date
10/02/2018
Last updated
10/02/2018
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