Doctor Name: | TIMOTHY MAHONEY |
NPI Number: | 1003850512 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW, LICSW |
License Number: | 02502 |
Business Practice Address: | 426 West Ave Red Wing, MN - 550662473 |
Business Phone Number: | 6513856180 |
Business Fax Number: | 6513856195 |
Mailing Address: | 426 West Ave, RED WING |
State: | MN |
Postal Code: | 550662473 |
Phone Number: | 6513856180 |
Fax Number: | 6513856195 |
NPI Enumeration Date: | 06/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 02502 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |