Provider Demographics
NPI:1780695924
Name:MAHONEY, MARCIA COCHRAN (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:COCHRAN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:BYFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01922-1600
Mailing Address - Country:US
Mailing Address - Phone:978-270-1662
Mailing Address - Fax:
Practice Address - Street 1:2 AUSTIN LN
Practice Address - Street 2:
Practice Address - City:BYFIELD
Practice Address - State:MA
Practice Address - Zip Code:01922-1600
Practice Address - Country:US
Practice Address - Phone:978-270-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1248093OtherAETNA
MA495444OtherTUFTS
MAAA74066OtherHARVARD PILGRIM HEALTH CARE
MASP0170OtherBLUE CROSS BLUE SHIELD
MI700347OtherACN GROUP