Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 35SI00223800 | NJ |
N | 102L00000X | Psychologist | 35SI00223800 | NJ |
N | 103T00000X | Psychologist | 35SI00223800 | NJ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 35SI00223800 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00223800 | NJ |
N | 103TC1900X | Counseling Psychologist | 35SI00223800 | NJ |
N | 103TE1100X | Exercise & Sports Psychologist | 35SI00223800 | NJ |
N | 103TP2701X | Group Psychotherapist | 35SI00223800 | NJ |
NPI | 1649392671 |
---|---|
Provider Name | Dr. James L Mastrich JR. |
First Address | Kingston, NJ 08528-9601 |
Second Address | Kingston, NJ 08528-9601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |