Provider Demographics
NPI:1710751888
Name:MAHON, ALEXANDRA RYAN (LSW)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:RYAN
Last Name:MAHON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 SPRINGBROOK CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2745
Mailing Address - Country:US
Mailing Address - Phone:908-303-4191
Mailing Address - Fax:
Practice Address - Street 1:55 WETZEL DR STE 3
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1131
Practice Address - Country:US
Practice Address - Phone:717-465-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty