Provider Demographics
NPI:1548852841
Name:DEMATTEO, GERARD LOUIS (MA, LPC)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:LOUIS
Last Name:DEMATTEO
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1834
Mailing Address - Country:US
Mailing Address - Phone:201-933-2867
Mailing Address - Fax:
Practice Address - Street 1:161 W PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1934
Practice Address - Country:US
Practice Address - Phone:201-933-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00710900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health