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1154626950
JACK ANTHONY MATTACHIONE
FORT MYERS, FL
NPI
1154626950
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2011-01-26
Last Update Date
2011-01-26
Business Address
Mr. JACK ANTHONY MATTACHIONE
2180 MARAVILLA LN
FORT MYERS, FL 33901-7221
Phone number: 239-322-2970
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Mailing Address
Mr. JACK ANTHONY MATTACHIONE
4610 SW 20TH AVE
CAPE CORAL, FL 33914-1704
Phone number: 239-313-9472
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