Provider Demographics
NPI:1285645192
Name:MAHONEY, PRISCILLA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:57 EISENHOWER CIR
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482
Mailing Address - Country:US
Mailing Address - Phone:781-235-0081
Mailing Address - Fax:781-235-0081
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:STE 13
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-749-4600
Practice Address - Fax:781-741-8341
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA425914OtherHARVARD PILGRIM HEALTH CA
MA7774261OtherAETNA
MAKAP06597OtherBCBS OF MASS
MA04343088011OtherPACIFICARE BEHAVIORAL HEA
MA102269OtherTUFTS HEALTH PLAN
MA425914OtherHARVARD PILGRIM HEALTH CA