Provider Demographics
NPI:1306865993
Name:MAHON, KAREN ANNE (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:MAHON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANNE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:7 JASPER LN
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1297
Mailing Address - Country:US
Mailing Address - Phone:978-270-7698
Mailing Address - Fax:
Practice Address - Street 1:7 JASPER LN
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1297
Practice Address - Country:US
Practice Address - Phone:978-270-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1153441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA115344OtherLICSW