Provider Demographics
NPI:1962807461
Name:PAUL J MAHLER LCSW LLC
Entity type:Organization
Organization Name:PAUL J MAHLER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-459-6942
Mailing Address - Street 1:29 LIVERY POOL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-2218
Mailing Address - Country:US
Mailing Address - Phone:860-459-6942
Mailing Address - Fax:860-909-0263
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3832
Practice Address - Country:US
Practice Address - Phone:860-459-6942
Practice Address - Fax:860-909-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty