Healthcare Provider Details

I. General information

NPI: 1124085063
Provider Name (Legal Business Name): PETER J. PATERNO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

62 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

V. Phone/Fax

Practice location:
  • Phone: 201-951-4800
  • Fax: 973-379-8804
Mailing address:
  • Phone: 201-951-4800
  • Fax: 973-379-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00600100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: