Provider Demographics
NPI:1407264021
Name:MAHORNEY, ANGELA (MSSW, CSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MAHORNEY
Suffix:
Gender:F
Credentials:MSSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 OLD LAIR RD
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-4628
Mailing Address - Country:US
Mailing Address - Phone:859-333-6988
Mailing Address - Fax:
Practice Address - Street 1:1154A LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-383-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2551631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY255163OtherBOARD OF SOCIAL WORK
KY1790731081Medicaid
KY265576OtherKENTUCKY BOARD OF LICENSURE OF MARRIAGE AND FAMILY THERAPISTS