1780108514 NPI number — MRS. JAYME SROKA MAHONEY LCMFT

Table of content: MRS. JAYME SROKA MAHONEY LCMFT (NPI 1780108514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780108514 NPI number — MRS. JAYME SROKA MAHONEY LCMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHONEY
Provider First Name:
JAYME
Provider Middle Name:
SROKA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SROKA
Provider Other First Name:
JAYME
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780108514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 N. MAIN ST. STE. C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-641-4598
Provider Business Mailing Address Fax Number:
410-641-4696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 N. MAIN ST. STE. C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-641-4598
Provider Business Practice Location Address Fax Number:
410-641-4696
Provider Enumeration Date:
08/02/2017

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: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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