Provider Demographics
NPI:1902822810
Name:MAHLER, CLIFFORD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:R
Last Name:MAHLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DANEBROCK DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3430
Mailing Address - Country:US
Mailing Address - Phone:716-832-5074
Mailing Address - Fax:716-862-8886
Practice Address - Street 1:15 DANEBROCK DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3430
Practice Address - Country:US
Practice Address - Phone:716-832-5074
Practice Address - Fax:716-862-8886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005391-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0766Medicare ID - Type Unspecified