Provider Demographics
NPI:1730546979
Name:GATTUSO, MARK J JR
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:GATTUSO
Suffix:JR
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 1:90 W AFTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1421
Mailing Address - Country:US
Mailing Address - Phone:877-636-9322
Mailing Address - Fax:
Practice Address - Street 1:90 W AFTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1421
Practice Address - Country:US
Practice Address - Phone:877-636-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)