Provider Demographics
NPI:1275669483
Name:MAHONEY, GAIL D (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:D
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1130
Mailing Address - Country:US
Mailing Address - Phone:509-838-2256
Mailing Address - Fax:509-838-2256
Practice Address - Street 1:1220 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1130
Practice Address - Country:US
Practice Address - Phone:509-838-2256
Practice Address - Fax:509-838-2256
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006192101YM0800X
WALW000063001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8800286Medicare PIN