Provider Demographics
NPI:1942596671
Name:MCMAHON, MARICEL GARCIA (CAGS)
Entity Type:Individual
Prefix:MS
First Name:MARICEL
Middle Name:GARCIA
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2471
Mailing Address - Country:US
Mailing Address - Phone:860-985-4316
Mailing Address - Fax:
Practice Address - Street 1:15 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2471
Practice Address - Country:US
Practice Address - Phone:860-985-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool