Provider Demographics
NPI:1851697718
Name:MAHONEY, DEBRA ROBIN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ROBIN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5740
Mailing Address - Country:US
Mailing Address - Phone:310-379-1387
Mailing Address - Fax:
Practice Address - Street 1:20101 HAMILTON AVE STE 155
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1314
Practice Address - Country:US
Practice Address - Phone:310-379-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical