Provider Demographics
NPI:1245492859
Name:MAHONEY-TOTH, LISA NOEL (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NOEL
Last Name:MAHONEY-TOTH
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 1:3970 SUMMERVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1826
Mailing Address - Country:US
Mailing Address - Phone:917-548-5687
Mailing Address - Fax:
Practice Address - Street 1:175 W 79TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6450
Practice Address - Country:US
Practice Address - Phone:917-548-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04219111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical