Provider Demographics
NPI:1811001845
Name:O MAHONY, THOMAS M (LICSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:O MAHONY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 HERMITAGE HILLS BLVD APT 10
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3423
Mailing Address - Country:US
Mailing Address - Phone:724-877-8595
Mailing Address - Fax:724-297-3131
Practice Address - Street 1:50 SNYDER RD STE 1
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3432
Practice Address - Country:US
Practice Address - Phone:724-877-8595
Practice Address - Fax:724-297-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
105191OtherUBH
PA1032387850003Medicaid
23165-3OtherBC BS