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General NPI Number Information
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NPI Number | 1093928806
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Entity Type | Individual
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Provider Name | SUSAN FAY MAHONEY APRN, BC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 124 PROFESSORS ROW TUFTS UNIVERSITY HEALTH SERVICE
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City | MEDFORD
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State | MA
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Zip | 02155-5816
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Country | US
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Telephone | 617-627-3350
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Fax | 617-627-3592
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Provider Business Mailing Address
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Address Line | 123 FISHER ST
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City | WESTWOOD
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State | MA
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Zip | 02090-3618
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Country | US
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Telephone | 781-320-8164
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Fax | 617-627-3592
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 163934
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License Number State | MA
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