Healthcare Provider Details

I. General information

NPI: 1902028301
Provider Name (Legal Business Name): PATRICIA B. MAHANEY ACSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISH B. MAHANEY LCSW

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 WILES ROAD, SUITE 105
CORAL SPRINGS FL
33065
US

IV. Provider business mailing address

1423 SE 14TH AVE.
DEERFIELD BEACH FL
33441
US

V. Phone/Fax

Practice location:
  • Phone: 954-341-1022
  • Fax: 954-341-1082
Mailing address:
  • Phone: 954-480-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 7911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: