Provider Demographics
NPI:1902427826
Name:MAHONEY, TARA COLLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:COLLEEN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1151
Mailing Address - Country:US
Mailing Address - Phone:201-454-2445
Mailing Address - Fax:
Practice Address - Street 1:158 FLOCKTOWN RD
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3545
Practice Address - Country:US
Practice Address - Phone:201-454-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00627800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional