Healthcare Provider Details

I. General information

NPI: 1326062670
Provider Name (Legal Business Name): MARK FRANK CETTA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 COUNTY RD
CRESSKILL NJ
07626-2266
US

IV. Provider business mailing address

145 COUNTY RD
CRESSKILL NJ
07626-2266
US

V. Phone/Fax

Practice location:
  • Phone: 201-784-0824
  • Fax:
Mailing address:
  • Phone: 201-784-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00127100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: