MEDICARE: MS. NICOLE C MC MAHON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1346369444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE C MC MAHON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 341403
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-9403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6519 8TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-4313
Country	:	US
Telephone Number	:	323-750-5167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/03/2013

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