Provider Demographics
NPI:1730196254
Name:MAHER, MARILYN HAAS (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:HAAS
Last Name:MAHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 RADCLIFFE PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2120
Mailing Address - Country:US
Mailing Address - Phone:303-775-3621
Mailing Address - Fax:303-485-5051
Practice Address - Street 1:1400 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2413
Practice Address - Country:US
Practice Address - Phone:303-775-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2359103TC0700X
CAPSY11743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical