Provider Demographics
NPI:1548698418
Name:MAHONEY, LINDA (MFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 ROSITA RD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4223
Mailing Address - Country:US
Mailing Address - Phone:650-888-6898
Mailing Address - Fax:
Practice Address - Street 1:90 EUREKA SQ
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2653
Practice Address - Country:US
Practice Address - Phone:650-888-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist