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General NPI Number Information
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NPI Number | 1407159296
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Entity Type | Individual
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Provider Name | MAKSYM LIDER LMHC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 7620 BAY PKWY SUITE 1C
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City | BROOKLYN
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State | NY
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Zip | 11214-1532
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Country | US
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Telephone | 516-313-6268
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Fax |
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Provider Business Mailing Address
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Address Line | 231 GRANT AVE UNIT 18
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City | POMPTON LAKES
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State | NJ
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Zip | 07442-1103
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Country | US
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Telephone | 516-313-6268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5511
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License Number State | NY
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