Provider Demographics
NPI:1316579535
Name:LAPORTA, MARIA (PSYD, BCB, NCSP)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:LAPORTA
Suffix:
Gender:F
Credentials:PSYD, BCB, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N MAPLE AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3261
Mailing Address - Country:US
Mailing Address - Phone:551-250-1017
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE STE 101B
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3261
Practice Address - Country:US
Practice Address - Phone:551-250-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100622400103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist