Provider Demographics
NPI:1437908928
Name:MASTBETH, TAYLORE ALLIE
Entity type:Individual
Prefix:
First Name:TAYLORE
Middle Name:ALLIE
Last Name:MASTBETH
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 1:908 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1909
Mailing Address - Country:US
Mailing Address - Phone:551-266-1919
Mailing Address - Fax:
Practice Address - Street 1:1 MEADOWLANDS PLZ STE 213
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2152
Practice Address - Country:US
Practice Address - Phone:201-340-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst