Provider Demographics
NPI:1710017884
Name:MAHONEY, ROBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3648
Mailing Address - Country:US
Mailing Address - Phone:325-665-0618
Mailing Address - Fax:325-572-5423
Practice Address - Street 1:364 ALEXANDRA DR
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-3648
Practice Address - Country:US
Practice Address - Phone:325-665-0618
Practice Address - Fax:325-572-5423
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS119651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical