Provider Demographics
NPI:1558036822
Name:MAHONEY, JAMES (LICSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1320
Mailing Address - Country:US
Mailing Address - Phone:973-770-5505
Mailing Address - Fax:
Practice Address - Street 1:200 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1320
Practice Address - Country:US
Practice Address - Phone:973-770-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121485-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical