Provider Demographics
NPI:1225487713
Name:FREEDOM FIRST PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:FREEDOM FIRST PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-560-4277
Mailing Address - Street 1:4 AVIS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2650
Mailing Address - Country:US
Mailing Address - Phone:518-560-4277
Mailing Address - Fax:518-662-4277
Practice Address - Street 1:4 AVIS DR STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2650
Practice Address - Country:US
Practice Address - Phone:518-560-4277
Practice Address - Fax:518-662-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021170-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty