Provider Demographics
NPI:1982942504
Name:MAHONEY, MARY E (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ESKEW CT
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-6619
Mailing Address - Country:US
Mailing Address - Phone:845-649-5393
Mailing Address - Fax:
Practice Address - Street 1:468 NEW YORK 17A
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-0195
Practice Address - Country:US
Practice Address - Phone:845-651-2251
Practice Address - Fax:845-651-2258
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker