Provider Demographics
NPI:1124296108
Name:MAHONEY, DIANE K (PHD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 MORLEY RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5907
Mailing Address - Country:US
Mailing Address - Phone:440-350-1932
Mailing Address - Fax:440-357-1558
Practice Address - Street 1:6835 MORLEY RD
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-5907
Practice Address - Country:US
Practice Address - Phone:440-350-1932
Practice Address - Fax:440-357-1558
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH620004908OtherRAILROAD MEDICARE