Provider Demographics
NPI:1043363229
Name:TOMMASI, MARIO (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:TOMMASI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BOND PL
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4517
Mailing Address - Country:US
Mailing Address - Phone:856-642-9090
Mailing Address - Fax:
Practice Address - Street 1:3 BOND PL
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-4517
Practice Address - Country:US
Practice Address - Phone:856-642-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical