Provider Demographics
NPI:1053485474
Name:MAHONEY, ELAINE L (RNC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:L
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01534-1040
Mailing Address - Country:US
Mailing Address - Phone:508-234-7263
Mailing Address - Fax:
Practice Address - Street 1:206 MILFORD ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1309
Practice Address - Country:US
Practice Address - Phone:508-529-7000
Practice Address - Fax:508-529-7024
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health