Jacqueline Cooper Mahoney, PH.D.
Individual provider Active NPI Clinical Psychologist · Perryville, MD
NPI 1811540974 · NPPES record last updated Jul 18, 2019
Key facts
- NPI
- 1811540974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- B10001179 (DE)
- Practice address
- 515 Broad St
Perryville, MD 21903-2734 - Phone
- (410) 642-2411
- NPI assigned
- Jul 18, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B10001179 | DE | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | B10001179 | DE | Yes |
Addresses
Primary practice location
515 Broad St
Perryville, MD 21903-2734
Mailing address
20981 Coastal Hwy # 12
Rehoboth Beach, DE 19971-8003
Phone (202) 203-9541
Other names
- Jacqueline Cooper Reyner
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.va.gov |
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All providers in Perryville, MD · Clinical Psychologist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.