Healthcare Provider Details

I. General information

NPI: 1003441304
Provider Name (Legal Business Name): JOHN ANTHONY MCMAHON III BCBA, M.ED, B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 KILVERT ST
WARWICK RI
02886-1370
US

IV. Provider business mailing address

491 KILVERT ST
WARWICK RI
02886-1370
US

V. Phone/Fax

Practice location:
  • Phone: 401-618-6991
  • Fax: 401-618-6995
Mailing address:
  • Phone: 401-618-6991
  • Fax: 401-618-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: