Provider Demographics
NPI:1922609007
Name:MAHAFFEY, GRACE KATHRYN
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KATHRYN
Last Name:MAHAFFEY
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 1:23402 LYONS AVE # 304A
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2511
Mailing Address - Country:US
Mailing Address - Phone:661-702-0166
Mailing Address - Fax:661-702-0169
Practice Address - Street 1:23402 LYONS AVE # 304A
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2511
Practice Address - Country:US
Practice Address - Phone:661-702-0166
Practice Address - Fax:661-702-0169
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician