MEDICARE: MRS. ROSITA AGUILO MAHONY LCSW, BCD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3221	HI

General Provider Information

NPI Number	:	1194795278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSITA AGUILO MAHONY LCSW, BCD

Provider Business Mailing Address
First Line	:	PSC 490 BOX 9036
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96538
Country	:	US
Telephone Number	:	671-344-9401
Fax Number	:	671-344-9522

Provider Business Practice Location Address
First Line	:	FARENHOLT STREET
Second Line	:	BUILDING K-1
City	:	AGANA HEIGHTS
State	:	GU
Zip	:	96919
Country	:	US
Telephone Number	:	671-344-9401
Fax Number	:	671-344-9522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/21/2022

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