Provider Demographics
NPI:1508078064
Name:MAHONEY, MARY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19805 SUMTER WAY
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2231
Mailing Address - Country:US
Mailing Address - Phone:301-972-8518
Mailing Address - Fax:
Practice Address - Street 1:19805 SUMTER WAY
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2231
Practice Address - Country:US
Practice Address - Phone:301-972-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health