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General NPI Number Information
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NPI Number | 1790227742
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Entity Type | Organization
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Legal Business Name | SARAH L. MCMAHON, LCSW, LLC
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 450 E 22ND ST SUITE 150
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City | LOMBARD
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State | IL
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Zip | 60148-6113
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Country | US
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Telephone | 312-404-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 22W785 RED OAK DR
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City | GLEN ELLYN
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State | IL
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Zip | 60137-7220
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Country | US
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Telephone | 312-404-2191
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Fax |
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Authorized Official
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Title or Position | MANAGER/CLINICIAN
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Name | SARAH L MCMAHON
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Credential | LCSW
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Telephone | 312-404-2191
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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 | 149014463
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License Number State | IL
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