1851718282 NPI number — DR. MATTHEW JOHN MAHER PHD, LMHC, BCBA

Table of content: DR. MATTHEW JOHN MAHER PHD, LMHC, BCBA (NPI 1851718282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851718282 NPI number — DR. MATTHEW JOHN MAHER PHD, LMHC, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHER
Provider First Name:
MATTHEW
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LMHC, BCBA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAHER
Provider Other First Name:
MATT
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, LMHC, LBA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851718282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12401-3828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-481-0481
Provider Business Mailing Address Fax Number:
888-728-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
184-548-1048
Provider Business Practice Location Address Fax Number:
888-728-0033
Provider Enumeration Date:
03/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103K00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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