Provider Demographics
NPI:1497143770
Name:MAHONY, ELLEN BANE (RN, IBCLC, LCCE)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:BANE
Last Name:MAHONY
Suffix:
Gender:F
Credentials:RN, IBCLC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-2129
Mailing Address - Country:US
Mailing Address - Phone:845-477-2937
Mailing Address - Fax:
Practice Address - Street 1:60 ELM ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD LAKE
Practice Address - State:NY
Practice Address - Zip Code:10925-2129
Practice Address - Country:US
Practice Address - Phone:845-477-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254086163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
19010568OtherIBCLE
NY254086OtherOFFICE OF THE PROFESSIONS
21116OtherLAMAZE INTERNATIONSAL