Provider Demographics
NPI:1346636933
Name:MAHONEY, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 980268
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298
Mailing Address - Country:US
Mailing Address - Phone:804-828-0762
Mailing Address - Fax:804-828-7675
Practice Address - Street 1:DIVISION OF CL PSYCHIATRY VCU HEALTH 1200 E BROAD STREE
Practice Address - Street 2:WII E
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1359
Practice Address - Country:US
Practice Address - Phone:804-828-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA01012689172084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program