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General NPI Number Information
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NPI Number | 1174853519
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Entity Type | Individual
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Provider Name | REBECCA JOY MCMAHON L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 1015 12TH ST SUITE 8
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City | MODESTO
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State | CA
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Zip | 95354-0838
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Country | US
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Telephone | 209-480-2038
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Fax | 209-522-2993
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Provider Business Mailing Address
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Address Line | PO BOX 81
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City | SALIDA
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State | CA
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Zip | 95368-0081
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Country | US
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Telephone | 209-480-2038
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Fax | 209-522-2993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 21518
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License Number State | CA
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