Healthcare Provider Details

I. General information

NPI: 1194795278
Provider Name (Legal Business Name): ROSITA AGUILO MAHONY LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ROSITA A MAHONY LCSW, BCD

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARENHOLT STREET BUILDING K-1
AGANA HEIGHTS GU
96919
US

IV. Provider business mailing address

PSC 490 BOX 9036
FPO AP
96538
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9401
  • Fax: 671-344-9522
Mailing address:
  • Phone: 671-344-9401
  • Fax: 671-344-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3221
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: