Active NPI
Jacqueline Matacchiera
- Professional Counselor
- Mountain Lakes, NJ
National Provider Identifier
1669957080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37PC00585900
- Practice address
- 420 Boulevard Ste 101
Mountain Lakes, NJ 07046-1733 - Phone
- (973) 988-0035
- NPI assigned
- Oct 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 37LC00279900 | NJ | |
| Professional Counselor | 101YP2500X | 37PC00585900 | NJ | Primary |
Addresses
Primary practice location
420 Boulevard Ste 101
Mountain Lakes, NJ 07046-1733
Mailing address
40 Gates PL
Wayne, NJ 07470-3217
Phone (201) 724-1190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | DO SERVE MEDICAID CLIENTS AS OF YET |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37LC00279900 | NJ | MD | Addiction (Substance Use Disorder) Counselor |
| 37PC00585900 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538438400000",
"number": "1669957080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 GATES PL",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074703217",
"telephone_number": "201-724-1190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 BOULEVARD STE 101",
"city": "MOUNTAIN LAKES",
"state": "NJ",
"postal_code": "070461733",
"telephone_number": "973-988-0035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATACCHIERA",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-02",
"last_updated": "2018-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NJ",
"license": "37LC00279900",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC00585900",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DO SERVE MEDICAID CLIENTS AS OF YET",
"identifier": "NONE",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountain Lakes, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.