Provider Demographics
NPI:1902028301
Name:MAHANEY, PATRICIA B (ACSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:MAHANEY
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:B
Other - Last Name:MAHANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1423 SE 14TH AVE.
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-480-2944
Mailing Address - Fax:
Practice Address - Street 1:7501 WILES ROAD, SUITE 105
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-341-1022
Practice Address - Fax:954-341-1082
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 79111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical