Provider Demographics
NPI:1649997545
Name:MCMAHON, LINDSAY RAE
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RAE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5410
Mailing Address - Country:US
Mailing Address - Phone:908-421-3381
Mailing Address - Fax:
Practice Address - Street 1:161 WASHINGTON VALLEY RD STE 207
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7177
Practice Address - Country:US
Practice Address - Phone:908-421-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00682100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health