Provider Demographics
NPI:1184746208
Name:MAHONEY, PATRICK JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 N KENSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1328
Mailing Address - Country:US
Mailing Address - Phone:703-243-4366
Mailing Address - Fax:703-243-4366
Practice Address - Street 1:1634 I ST NW
Practice Address - Street 2:SUITE 700
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-4003
Practice Address - Country:US
Practice Address - Phone:202-639-4960
Practice Address - Fax:703-243-4366
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1488103T00000X
VA0810003140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC490524Medicare ID - Type Unspecified