Provider Demographics
NPI:1376042531
Name:MAHONEY, ERICA J (MHC-L)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:J
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MHC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MALLARDS LNDG S
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1070
Mailing Address - Country:US
Mailing Address - Phone:518-560-0980
Mailing Address - Fax:
Practice Address - Street 1:37 MALLARDS LNDG S
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-1070
Practice Address - Country:US
Practice Address - Phone:518-560-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP09412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health