Provider Demographics
NPI:1659491447
Name:MATTA, WILLIAM J (EDD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MATTA
Suffix:
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 1:13 TOMLINSON MILL RD
Mailing Address - Street 2:COUNSELING ASSOCIATES OF MEDFORD
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:856-396-0080
Mailing Address - Fax:856-983-4375
Practice Address - Street 1:13 TOMLINSON MILL RD
Practice Address - Street 2:COUNSELING ASSOCIATES OF MEDFORD
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:856-396-0080
Practice Address - Fax:856-983-4375
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00161300101Y00000X
NJ37F100142200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023248Medicare ID - Type Unspecified