Provider Demographics
NPI:1427328418
Name:MAHONEY, ELIZABETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 ROCK CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2038
Mailing Address - Country:US
Mailing Address - Phone:571-226-7977
Mailing Address - Fax:
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:703-378-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical