1174611685 NPI number — MRS. LINDA ANN MAHONEY LCDP, CDCS

Table of content: MRS. LINDA ANN MAHONEY LCDP, CDCS (NPI 1174611685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174611685 NPI number — MRS. LINDA ANN MAHONEY LCDP, CDCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHONEY
Provider First Name:
LINDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCDP, CDCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174611685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 BAKER PINES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMING
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-539-3002
Provider Business Mailing Address Fax Number:
401-539-8505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 BAKER PINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02898-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-539-3002
Provider Business Practice Location Address Fax Number:
401-539-8505
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCDCS 100600 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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