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General NPI Number Information
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NPI Number | 1477058998
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Entity Type | Organization
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Legal Business Name | NORTHSIDE PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 331 LEONARD ST STE 1F
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City | BROOKLYN
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State | NY
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Zip | 11211-2309
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Country | US
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Telephone | 718-669-1919
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Fax | 347-308-5985
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Provider Business Mailing Address
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Address Line | 331 LEONARD ST STE 1F
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City | BROOKLYN
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State | NY
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Zip | 11211-2309
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Country | US
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Telephone | 718-669-1919
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Fax | 347-308-5985
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. DAVID MAHONY
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Credential | PHD
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Telephone | 718-668-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013606
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License Number State | NY
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