Healthcare Provider Details

I. General information

NPI: 1083790620
Provider Name (Legal Business Name): MARY NEWMAN MCMAHON PHD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL COURT
BELLOWS FALLS VT
05101
US

IV. Provider business mailing address

ONE HOSPITAL COURT SUITE 410
BELLOWS FALLS VT
05101
US

V. Phone/Fax

Practice location:
  • Phone: 802-463-3294
  • Fax: 802-463-1202
Mailing address:
  • Phone: 802-463-3947
  • Fax: 802-463-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0890000429
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: