Provider Demographics
NPI:1063592517
Name:MAHAR, PETER MICHAEL (MS, LCMHC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:MAHAR
Suffix:
Gender:M
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:VT
Mailing Address - Zip Code:05735-0422
Mailing Address - Country:US
Mailing Address - Phone:802-773-1411
Mailing Address - Fax:802-773-9811
Practice Address - Street 1:128 MERCHANTS ROW
Practice Address - Street 2:OFFICE 602
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5909
Practice Address - Country:US
Practice Address - Phone:802-773-1411
Practice Address - Fax:802-773-9811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT080-38696OtherBLUE CROSS BLUE SHIELD VT
VT307092OtherMAGELLAN
VT61874OtherMVP HEALTH CARE
VT1007096Medicaid
VT2039313OtherCIGNA