Provider Demographics
NPI:1699406843
Name:MAHANEY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MAHANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6325
Mailing Address - Country:US
Mailing Address - Phone:443-340-9948
Mailing Address - Fax:
Practice Address - Street 1:531 OLD WESTMINSTER PIKE STE 103
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6277
Practice Address - Country:US
Practice Address - Phone:443-340-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA1206103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst