Provider Demographics
NPI:1407159296
Name:LIDER, MAKSYM (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MAKSYM
Middle Name:
Last Name:LIDER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 GRANT AVE
Mailing Address - Street 2:UNIT 18
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1103
Mailing Address - Country:US
Mailing Address - Phone:516-313-6268
Mailing Address - Fax:
Practice Address - Street 1:7620 BAY PKWY
Practice Address - Street 2:SUITE 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1532
Practice Address - Country:US
Practice Address - Phone:516-313-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5511101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor