Healthcare Provider Details

I. General information

NPI: 1225487713
Provider Name (Legal Business Name): FREEDOM FIRST PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 AVIS DR STE 101
LATHAM NY
12110-2650
US

IV. Provider business mailing address

4 AVIS DR STE 101
LATHAM NY
12110-2650
US

V. Phone/Fax

Practice location:
  • Phone: 518-560-4277
  • Fax: 518-662-4277
Mailing address:
  • Phone: 518-560-4277
  • Fax: 518-662-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number021170-1
License Number StateNY

VIII. Authorized Official

Name: DR. ALICIA MAHLER
Title or Position: PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 518-560-4277