Provider Demographics
NPI:1932220159
Name:MAYER, WILLIAM F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:MAYER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:F
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:411 PEQUOT AVE
Mailing Address - Street 2:P.O. BOX 843
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-3303
Mailing Address - Country:US
Mailing Address - Phone:203-939-1535
Mailing Address - Fax:
Practice Address - Street 1:411 PEQUOT AVE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-3303
Practice Address - Country:US
Practice Address - Phone:203-939-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002496103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist