1285645192 NPI number — MS. PRISCILLA M MAHONEY LICSW

Table of content: MS. PRISCILLA M MAHONEY LICSW (NPI 1285645192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285645192 NPI number — MS. PRISCILLA M MAHONEY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHONEY
Provider First Name:
PRISCILLA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1285645192
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:
57 EISENHOWER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-235-0081
Provider Business Mailing Address Fax Number:
781-235-0081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 DERBY ST
Provider Second Line Business Practice Location Address:
STE 13
Provider Business Practice Location Address City Name:
HINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-749-4600
Provider Business Practice Location Address Fax Number:
781-741-8341
Provider Enumeration Date:
08/10/2006

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: 1041C0700X , with the licence number:  1022695 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 425914 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7774261 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: KAP06597 . This is a "BCBS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04343088011 . This is a "PACIFICARE BEHAVIORAL HEA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 102269 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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