Provider Demographics
NPI:1780458737
Name:MAZZA, PATRICE ROSE (BCBA)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:ROSE
Last Name:MAZZA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:ROSE
Other - Last Name:DEBONIS-PERROTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 MAIN ST APT 48
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4714
Mailing Address - Country:US
Mailing Address - Phone:201-207-2938
Mailing Address - Fax:
Practice Address - Street 1:329 AYCRIGG AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3713
Practice Address - Country:US
Practice Address - Phone:973-933-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst