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General NPI Number Information
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NPI Number | 1780458737
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Entity Type | Individual
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Provider Name | PATRICE ROSE MAZZA BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 329 AYCRIGG AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-3713
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Country | US
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Telephone | 973-933-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 85 MAIN ST APT 48
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4714
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Country | US
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Telephone | 201-207-2938
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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