Healthcare Provider Details

I. General information

NPI: 1932481405
Provider Name (Legal Business Name): MARY KAY HAFER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 STATE HIGHWAY 56
COLTON NY
13625
US

IV. Provider business mailing address

101 STATE HIGHWAY 72
POTSDAM NY
13676-3477
US

V. Phone/Fax

Practice location:
  • Phone: 315-262-2100
  • Fax:
Mailing address:
  • Phone: 315-265-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: