Provider Demographics
NPI:1366869992
Name:MAH, DONNA M (LAC, LMSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:MAH
Suffix:
Gender:F
Credentials:LAC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 15TH ST OFC A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3959
Mailing Address - Country:US
Mailing Address - Phone:917-453-1778
Mailing Address - Fax:212-777-3228
Practice Address - Street 1:200 E 15TH ST OFC A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3959
Practice Address - Country:US
Practice Address - Phone:917-453-1778
Practice Address - Fax:212-777-3228
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1203831041C0700X
NY005265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical