Provider Demographics
NPI:1851718282
Name:MAHER, MATTHEW JOHN (PHD, LMHC, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:MAHER
Suffix:
Gender:M
Credentials:PHD, LMHC, BCBA
Other - Prefix:DR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC, LBA
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3828
Mailing Address - Country:US
Mailing Address - Phone:845-481-0481
Mailing Address - Fax:888-728-0033
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3828
Practice Address - Country:US
Practice Address - Phone:184-548-1048
Practice Address - Fax:888-728-0033
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst