Provider Demographics
NPI:1174853519
Name:MCMAHON, REBECCA JOY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JOY
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-0081
Mailing Address - Country:US
Mailing Address - Phone:209-480-2038
Mailing Address - Fax:209-522-2993
Practice Address - Street 1:1015 12TH ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0838
Practice Address - Country:US
Practice Address - Phone:209-480-2038
Practice Address - Fax:209-522-2993
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 215181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical