Healthcare Provider Details

I. General information

NPI: 1285645192
Provider Name (Legal Business Name): PRISCILLA M MAHONEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 DERBY ST STE 13
HINGHAM MA
02043
US

IV. Provider business mailing address

57 EISENHOWER CIR
WELLESLEY MA
02482
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-4600
  • Fax: 781-741-8341
Mailing address:
  • Phone: 781-235-0081
  • Fax: 781-235-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1022695
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: