Provider Demographics
NPI:1932481405
Name:HAFER, MARY KAY (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:HAFER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STATE HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3477
Mailing Address - Country:US
Mailing Address - Phone:315-265-9033
Mailing Address - Fax:
Practice Address - Street 1:4921 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:NY
Practice Address - Zip Code:13625
Practice Address - Country:US
Practice Address - Phone:315-262-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool