Provider Demographics
NPI:1649392671
Name:MASTRICH, JAMES L JR (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:MASTRICH
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-9601
Mailing Address - Country:US
Mailing Address - Phone:609-921-3665
Mailing Address - Fax:609-397-1971
Practice Address - Street 1:4475 ROUTE 27
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:08528-9601
Practice Address - Country:US
Practice Address - Phone:609-921-3665
Practice Address - Fax:609-397-1971
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00223800101YA0400X, 103T00000X, 103TA0400X, 103TB0200X, 103TC1900X, 103TE1100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy