Provider Demographics
NPI:1053341677
Name:MAHRER, JONATHAN DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:MAHRER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CAMINO ALTO STE 106
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2910
Mailing Address - Country:US
Mailing Address - Phone:415-567-7751
Mailing Address - Fax:866-295-5532
Practice Address - Street 1:61 CAMINO ALTO STE 106
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2910
Practice Address - Country:US
Practice Address - Phone:415-567-7751
Practice Address - Fax:866-295-5532
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA145580500OtherOWCP
CA145580500OtherOWCP