Provider Demographics
NPI:1578965109
Name:MCMAHON, ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6103
Mailing Address - Country:US
Mailing Address - Phone:440-266-0770
Mailing Address - Fax:440-266-0257
Practice Address - Street 1:8701 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6103
Practice Address - Country:US
Practice Address - Phone:440-266-0770
Practice Address - Fax:440-266-0257
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016017103T00000X
OH7603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist