Provider Demographics
NPI:1205675469
Name:COLAVITO, WILLIAM MATTHEW
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:COLAVITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BROCKTON CT
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1602
Mailing Address - Country:US
Mailing Address - Phone:732-762-6844
Mailing Address - Fax:
Practice Address - Street 1:32 BRUCE CT
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1320
Practice Address - Country:US
Practice Address - Phone:732-579-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-24-70753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst