MEDICARE: MS. PATRICIA A MAHONEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	22296	CA

General Provider Information

NPI Number	:	1700200888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA A MAHONEY LCSW

Provider Business Mailing Address
First Line	:	1267 ROSECRANS ST STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2692
Country	:	US
Telephone Number	:	619-301-5232
Fax Number	:	619-915-5962

Provider Business Practice Location Address
First Line	:	1267 ROSECRANS ST STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2692
Country	:	US
Telephone Number	:	619-301-5232
Fax Number	:	619-915-5962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2014
Last Update Date	:	11/18/2022

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