Provider Demographics
NPI:1760814313
Name:MAHONEY, CHERYL L
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:MAHONEY
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 1:131 N LUDLOW ST
Mailing Address - Street 2:248
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1116
Mailing Address - Country:US
Mailing Address - Phone:937-673-3428
Mailing Address - Fax:
Practice Address - Street 1:1900 COOLIDGE DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-2524
Practice Address - Country:US
Practice Address - Phone:937-673-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1000047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker