MEDICARE: MARY ELLEN MCMAHON

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	RO26701	NY

General Provider Information

NPI Number	:	1801817374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN MCMAHON

Provider Business Mailing Address
First Line	:	150 E 56TH ST
Second Line	:	SUITE 2-C
City	:	NEW YORK
State	:	NY
Zip	:	10022-3631
Country	:	US
Telephone Number	:	212-980-1925
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E 56TH ST
Second Line	:	SUITE 2-C
City	:	NEW YORK
State	:	NY
Zip	:	10022-3631
Country	:	US
Telephone Number	:	212-980-1925
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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