MEDICARE: KAITLIN 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	1041C0700X	Clinical Social Worker
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker	098528	NY
4	104100000X	Social Worker	106257	NY

General Provider Information

NPI Number	:	1689192916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN MCMAHON LCSW

Provider Business Mailing Address
First Line	:	18 FAIRFIELD DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2233
Country	:	US
Telephone Number	:	929-457-1102
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 FAIRFIELD DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2233
Country	:	US
Telephone Number	:	929-457-1102
Fax Number	:

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

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	03/09/2026

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