Provider Demographics
NPI:1063095230
Name:MAHON, ALEXANDER JOHN DAVID
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOHN DAVID
Last Name:MAHON
Suffix:
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 1:111 POWELTON CIR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2215
Mailing Address - Country:US
Mailing Address - Phone:845-542-0663
Mailing Address - Fax:
Practice Address - Street 1:205 SOUTH AVE STE 105
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4818
Practice Address - Country:US
Practice Address - Phone:845-554-1365
Practice Address - Fax:845-554-1376
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health