Healthcare Provider Details

I. General information

NPI: 1053341677
Provider Name (Legal Business Name): JONATHAN DAVID MAHRER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CAMINO ALTO STE 106
MILL VALLEY CA
94941-2910
US

IV. Provider business mailing address

61 CAMINO ALTO STE 106
MILL VALLEY CA
94941-2910
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-7751
  • Fax: 866-295-5532
Mailing address:
  • Phone: 415-567-7751
  • Fax: 866-295-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 14351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: