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General NPI Number Information
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NPI Number | 1922580026
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Entity Type | Individual
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Provider Name | KELLY M MAHONEY PMHNP- BC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 33 TOWER ST
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City | SOMERVILLE
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State | MA
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Zip | 02143-1426
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Country | US
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Telephone | 617-591-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 HUGUENOT TRL
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City | POWHATAN
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State | VA
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Zip | 23139-4308
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Country | US
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Telephone | 910-603-6162
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0024185585
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 239268
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2357709
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5010931
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License Number State | NC
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