Healthcare Provider Details

I. General information

NPI: 1922580026
Provider Name (Legal Business Name): KELLY M MAHONEY PMHNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TOWER ST
SOMERVILLE MA
02143-1426
US

IV. Provider business mailing address

2808 HUGUENOT TRL
POWHATAN VA
23139-4308
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-4500
  • Fax:
Mailing address:
  • Phone: 910-603-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024185585
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number239268
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2357709
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5010931
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: