Individual
KIMBERLY A MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 E 7TH ST, PUEBLO, CO 81001-3508
(719) 543-8711
(719) 543-0171
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 543-0171
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
9376
SC
1041C0700X
Clinical Social Worker
Primary
CSW.09926768
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760596480
—
SC
05
—
9000190485
—
CO
Enumeration date
04/29/2010
Last updated
02/01/2024
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