Provider Demographics
NPI:1952486128
Name:ZOTTA, MARA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:ZOTTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 VILLAGE CIR W
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5322
Mailing Address - Country:US
Mailing Address - Phone:551-206-9368
Mailing Address - Fax:
Practice Address - Street 1:48 S FRANKLIN TPKE
Practice Address - Street 2:STE 201
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2558
Practice Address - Country:US
Practice Address - Phone:551-206-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00530200103TC0700X
NY016846-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist