Provider Demographics
NPI:1942453501
Name:MCMAHON, LYNNE E (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:E
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:P.O. BOX 857
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1014
Mailing Address - Country:US
Mailing Address - Phone:860-517-9160
Mailing Address - Fax:
Practice Address - Street 1:17 FARMHILL DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1014
Practice Address - Country:US
Practice Address - Phone:860-517-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
D400001168Medicare PIN