Provider Demographics
NPI:1356692180
Name:ALTOMARE, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ALTOMARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7407
Mailing Address - Country:US
Mailing Address - Phone:609-703-1827
Mailing Address - Fax:
Practice Address - Street 1:615 LACEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2200
Practice Address - Country:US
Practice Address - Phone:609-242-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health