Individual
JENNIFER L MCMAHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
635 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 704-8034
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
007533
CT
104100000X
Social Worker
ISW01628
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00426338
—
CT
Enumeration date
01/22/2007
Last updated
02/09/2011
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