Provider Demographics
NPI:1790668408
Name:MAHONEY, STEPHANIE LYNN (BT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:BRYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1649 61ST ST FL 3013
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3319
Mailing Address - Country:US
Mailing Address - Phone:212-481-4040
Mailing Address - Fax:
Practice Address - Street 1:1653 QUEBEC AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:IA
Practice Address - Zip Code:50250-8202
Practice Address - Country:US
Practice Address - Phone:712-269-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst