Provider Demographics
NPI:1649226069
Name:MAHONY, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MAHONY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 LEONARD ST
Mailing Address - Street 2:STE 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2309
Mailing Address - Country:US
Mailing Address - Phone:718-668-1919
Mailing Address - Fax:347-384-2607
Practice Address - Street 1:331 LEONARD ST
Practice Address - Street 2:STE 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2309
Practice Address - Country:US
Practice Address - Phone:718-668-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS81015Medicare UPIN