Provider Demographics
NPI:1760711386
Name:MAHANNA, TONI-ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:TONI-ANN
Middle Name:
Last Name:MAHANNA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MAIN ST.
Mailing Address - Street 2:BROCKTON DISTRICT COURT BROCKTON JUVENILE COURT CLINIC
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02303
Mailing Address - Country:US
Mailing Address - Phone:508-897-4973
Mailing Address - Fax:508-897-4988
Practice Address - Street 1:215 MAIN ST.
Practice Address - Street 2:BROCKTON DISTRICT COURT
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02303
Practice Address - Country:US
Practice Address - Phone:508-897-4973
Practice Address - Fax:508-897-4988
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1028755104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker