Healthcare Provider Details

I. General information

NPI: 1396660692
Provider Name (Legal Business Name): TIMOTHY MAHONEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ALBERMARLE ST NW STE 500
WASHINGTON DC
20016
US

IV. Provider business mailing address

4000 ALBERMARLE ST NW STE 500
WASHINGTON DC
20016
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-5385
  • Fax:
Mailing address:
  • Phone: 202-531-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLG200008967
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: