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General NPI Number Information
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NPI Number | 1427328418
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Entity Type | Individual
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Provider Name | ELIZABETH MAHONEY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 4229 LAFAYETTE CENTER DR SUITE 1200
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City | CHANTILLY
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State | VA
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Zip | 20151-1261
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Country | US
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Telephone | 703-378-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 1349 ROCK CHAPEL RD
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City | HERNDON
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State | VA
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Zip | 20170-2038
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Country | US
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Telephone | 571-226-7977
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904006680
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License Number State | VA
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