Cornelius D Mahoney, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071003138 Issued in IL

Practice address

900 North Shore Dr
Ste 200
Lake Bluff, IL 60044-2243

Phone

(847) 295-0340

Fax

(847) 295-0351

NPI assigned

Jan 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417478400000",
    "number": "1003895657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NORTH SHORE DR",
            "address_2": "STE 200",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600442243",
            "telephone_number": "847-295-0340",
            "fax_number": "847-295-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NORTH SHORE DR",
            "address_2": "STE 200",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600442243",
            "telephone_number": "847-295-0340",
            "fax_number": "847-295-0351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "CORNELIUS",
        "middle_name": "D",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2014-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071003138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela B Lutes, NP-C
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• Kristen Martin, MS, OTR/L
• Jamie Lou Mason, LPC

• Clinical Psychologist in Lake Bluff, IL
• Providers in Lake Bluff, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.