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NPI Code Detail

MEDICARE: MRS. MARY LOUISE MCMAHON MSSA

MEDICARE: MRS. MARY LOUISE MCMAHON MSSA
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
11041C0700XClinical Social WorkerI 0001784OH

General Provider Information

NPI Number : 1356402796
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY LOUISE MCMAHON MSSA
Provider Business Mailing Address
First Line : 606 NOME AVE
Second Line :
City : AKRON
State : OH
Zip : 44320-1681
Country : US
Telephone Number : 330-836-5473
Fax Number : 330-798-1225
Provider Business Practice Location Address
First Line : 2161 EASTWOOD AVE
Second Line :
City : AKRON
State : OH
Zip : 44305-2179
Country : US
Telephone Number : 330-798-1220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 07/08/2007

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