Healthcare Provider Details

I. General information

NPI: 1700291044
Provider Name (Legal Business Name): TADD MAFFUCCI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MAIN ST STE F
FORKED RIVER NJ
08731-4653
US

IV. Provider business mailing address

900 BARNEGAT BLVD N UNIT 2104
BARNEGAT NJ
08005-2583
US

V. Phone/Fax

Practice location:
  • Phone: 609-693-4343
  • Fax: 609-693-4345
Mailing address:
  • Phone: 609-721-1715
  • Fax: 609-693-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00498700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: