Basic Information
| Provider Information | |||||||||
| NPI: | 1275818676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMAHON | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW, ICSW, CDS,CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 JOHN CLARKE RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018492300 | ||||||||
| FaxNumber: | 4018484156 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 JOHN CLARKE RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018492300 | ||||||||
| FaxNumber: | 4018484156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2011 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDS00058 | RI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | CDP00186 | RI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 008129 | CT | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | ISW02285 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.