Provider Demographics
NPI:1316436132
Name:MAHONEY, MARIANNE (BS, CADCI)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:BS, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 SW COAST HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4928
Mailing Address - Country:US
Mailing Address - Phone:541-574-9050
Mailing Address - Fax:541-574-9052
Practice Address - Street 1:332 SW COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4928
Practice Address - Country:US
Practice Address - Phone:541-574-9050
Practice Address - Fax:541-574-9052
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-04-21101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)