Provider Demographics
NPI:1053858290
Name:MAHONY, KATHLEEN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MAHONY
Suffix:
Gender:F
Credentials:LCPC
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 1229
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-1229
Mailing Address - Country:US
Mailing Address - Phone:410-356-9208
Mailing Address - Fax:443-200-0267
Practice Address - Street 1:2 LOCUST LN
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5075
Practice Address - Country:US
Practice Address - Phone:410-356-9208
Practice Address - Fax:443-200-0267
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional