Provider Demographics
NPI:1275818676
Name:MCMAHON, VINCENT JOHN (LCSW, ICSW, CDS,CDP)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOHN
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:LCSW, ICSW, CDS,CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 JOHN CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5641
Mailing Address - Country:US
Mailing Address - Phone:401-849-2300
Mailing Address - Fax:401-848-4156
Practice Address - Street 1:31 JOHN CLARKE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5641
Practice Address - Country:US
Practice Address - Phone:401-849-2300
Practice Address - Fax:401-848-4156
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDS00058101YA0400X
RICDP00186101YA0400X
CT0081291041C0700X
RIISW022851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)