Healthcare Provider Details

I. General information

NPI: 1326086687
Provider Name (Legal Business Name): THOMAS R MAYER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

585 SCHENECTADY AVE MANAGED CARE DEPT. - 6TH FLOOR, BLUMBERG BLDG.
BROOKLYN NY
11203-1809
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5270
  • Fax: 718-604-6629
Mailing address:
  • Phone: 718-604-5239
  • Fax: 718-604-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: