Healthcare Provider Details

I. General information

NPI: 1285547000
Provider Name (Legal Business Name): JENNIFER L MAHONEY LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 GODDARD PKWY
SALISBURY MD
21801-1126
US

IV. Provider business mailing address

102 W BUCKINGHAM RD
BERLIN MD
21811-1417
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-7823
  • Fax: 443-978-7827
Mailing address:
  • Phone: 443-523-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15853
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15853
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: