Healthcare Provider Details

I. General information

NPI: 1649392671
Provider Name (Legal Business Name): JAMES L MASTRICH JR. ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 ROUTE 27
KINGSTON NJ
08528-9601
US

IV. Provider business mailing address

4475 ROUTE 27
KINGSTON NJ
08528-9601
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-3665
  • Fax: 609-397-1971
Mailing address:
  • Phone: 609-921-3665
  • Fax: 609-397-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35SI00223800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00223800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number35SI00223800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number35SI00223800
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35SI00223800
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number35SI00223800
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number35SI00223800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: