Provider Demographics
NPI:1740512326
Name:MEHAFFEY, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MEHAFFEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 UNION ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4498
Mailing Address - Country:US
Mailing Address - Phone:201-652-6253
Mailing Address - Fax:201-652-6253
Practice Address - Street 1:174 UNION ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4498
Practice Address - Country:US
Practice Address - Phone:201-652-6253
Practice Address - Fax:201-652-6253
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA37PC00107100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional