Provider Demographics
NPI:1992864805
Name:MATTIACE, FRANK L (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:L
Last Name:MATTIACE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4040
Mailing Address - Country:US
Mailing Address - Phone:201-436-1022
Mailing Address - Fax:201-436-0277
Practice Address - Street 1:995 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4040
Practice Address - Country:US
Practice Address - Phone:201-436-1022
Practice Address - Fax:201-436-0277
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00292100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker