Provider Demographics
NPI:1093721888
Name:MAHONEY, NANCY B (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:B
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 IVY ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2011
Mailing Address - Country:US
Mailing Address - Phone:302-426-9991
Mailing Address - Fax:
Practice Address - Street 1:715 N TATNALL ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1715
Practice Address - Country:US
Practice Address - Phone:302-654-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional