Provider Demographics
NPI:1902343130
Name:MAGNOTTA, PATRICIA A
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MAGNOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 HIGHWAY 35
Mailing Address - Street 2:BLDG D, SUITE 201
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1918
Mailing Address - Country:US
Mailing Address - Phone:732-231-5170
Mailing Address - Fax:
Practice Address - Street 1:2517 HIGHWAY 35
Practice Address - Street 2:BLDG D, SUITE 201
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1918
Practice Address - Country:US
Practice Address - Phone:732-231-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05624100104100000X
NJ44SC057490001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker