MEDICARE: MAX MCMAHON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	220250	MA

General Provider Information

NPI Number	:	1134650401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX MCMAHON LCSW

Provider Business Mailing Address
First Line	:	402 HIGHLAND AVE
Second Line	:	SUITE G
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-2548
Country	:	US
Telephone Number	:	617-702-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 HIGHLAND AVE
Second Line	:	SUITE G
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-2548
Country	:	US
Telephone Number	:	617-702-9131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/27/2017

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