Provider Demographics
NPI:1033728779
Name:MAHONEY, BRIDGET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500938
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0938
Mailing Address - Country:US
Mailing Address - Phone:670-322-0035
Mailing Address - Fax:670-322-0038
Practice Address - Street 1:MARINA HEIGHTS
Practice Address - Street 2:BLDING II - SUITE 206
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-322-0035
Practice Address - Fax:670-322-0038
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500788311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical