Provider Demographics
NPI:1457899585
Name:MAHONEY, MARY AILEEN (BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AILEEN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:43B FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1809
Mailing Address - Country:US
Mailing Address - Phone:802-238-0950
Mailing Address - Fax:
Practice Address - Street 1:110 KIMBALL AVE STE 125
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6851
Practice Address - Country:US
Practice Address - Phone:802-489-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146-0132046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst