Provider Demographics
NPI:1225463987
Name:MAHONEY, HEATHER A (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:A
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 1:847 W MAIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3456
Mailing Address - Country:US
Mailing Address - Phone:203-444-2536
Mailing Address - Fax:844-308-5896
Practice Address - Street 1:79 TRUMBULL ST
Practice Address - Street 2:STE 1
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3782
Practice Address - Country:US
Practice Address - Phone:203-444-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health