Provider Demographics
NPI:1972843142
Name:MCMAHON, ROBERT CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
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 1:949 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6728
Mailing Address - Country:US
Mailing Address - Phone:916-290-3995
Mailing Address - Fax:
Practice Address - Street 1:300 PRISON RD
Practice Address - Street 2:FOLSOM STATE PRISON
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-3001
Practice Address - Country:US
Practice Address - Phone:916-985-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical