Provider Demographics
NPI:1609179977
Name:MCMAHON, DIANE (LPC, RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1725
Mailing Address - Country:US
Mailing Address - Phone:609-937-5881
Mailing Address - Fax:856-556-3772
Practice Address - Street 1:133 FRANKLIN CORNER RD
Practice Address - Street 2:2ND FLOOR PSYCHOTHERAPY SUITE
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2531
Practice Address - Country:US
Practice Address - Phone:609-937-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00374900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ08779818Medicaid