Healthcare Provider Details

I. General information

NPI: 1114707841
Provider Name (Legal Business Name): SUSAN F MAHONEY PMHCNS PSYCHIATRIC/MENTAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 MASSACHUSETTS AVE FL 3
ARLINGTON MA
02474-8406
US

IV. Provider business mailing address

20 UNION ST
MELROSE MA
02176-2207
US

V. Phone/Fax

Practice location:
  • Phone: 781-223-1663
  • Fax:
Mailing address:
  • Phone: 781-223-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN FAY MAHONEY
Title or Position: CLINICAL NURSE SPECIALIST
Credential: PMHCNS-BC
Phone: 781-223-1663