Provider Demographics
NPI:1518988922
Name:MCMAHON, THOMAS WILLIAM (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2910
Mailing Address - Country:US
Mailing Address - Phone:978-852-5046
Mailing Address - Fax:
Practice Address - Street 1:435 NEWBURY ST
Practice Address - Street 2:SUITE 220
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1065
Practice Address - Country:US
Practice Address - Phone:978-852-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02418Medicare ID - Type Unspecified