=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609015817
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY MAHONEY CSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 02/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11344 COLOMA RD STE 709
-----------------------------------------------------
City | GOLD RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-4464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-459-4604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11344 COLOMA RD STE 709
-----------------------------------------------------
City | GOLD RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-4464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-459-4604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS25278
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------