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General NPI Number Information
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NPI Number | 1700516127
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Entity Type | Individual
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Provider Name | MEARA HENNINGER-MCMAHON PHD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 475 IRVING AVE STE 300
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City | SYRACUSE
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State | NY
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Zip | 13210-2306
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Country | US
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Telephone | 315-464-3555
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Fax | 315-464-3551
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Provider Business Mailing Address
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Address Line | 475 IRVING AVE STE 300
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City | SYRACUSE
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State | NY
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Zip | 13210-2306
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Country | US
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Telephone | 315-464-3555
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Fax | 315-464-3551
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 027852
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-27408
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY004891
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License Number State | GA
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