Provider Demographics
NPI:1679502942
Name:PATANIA, MARIA TERESE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:TERESE
Last Name:PATANIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 POMPTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-3255
Mailing Address - Country:US
Mailing Address - Phone:973-835-6337
Mailing Address - Fax:
Practice Address - Street 1:31 POMOPTON AVENUE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442
Practice Address - Country:US
Practice Address - Phone:973-835-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05174900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health