Provider Demographics
NPI:1730242496
Name:MAHONEY, CORNELIUS JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:JOSEPH
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1918
Mailing Address - Country:US
Mailing Address - Phone:973-623-0497
Mailing Address - Fax:973-623-2030
Practice Address - Street 1:467 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2622
Practice Address - Country:US
Practice Address - Phone:908-277-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA853483Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER