Basic Information
| Provider Information | |||||||||
| NPI: | 1225328867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHORNEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | B.C.B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11990 SPRINGVIEW DR | ||||||||
| Address2: | |||||||||
| City: | LA MIRADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906381126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627620897 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9531 PITTSBURGH AVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917306008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2011 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-09-5042 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.