Provider Demographics
NPI:1871220012
Name:MCMAHON, THERESA C
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:C
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 FAIRMOUNT AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2869
Mailing Address - Country:US
Mailing Address - Phone:516-313-0895
Mailing Address - Fax:
Practice Address - Street 1:430 FAIRMOUNT AVE APT 501
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2869
Practice Address - Country:US
Practice Address - Phone:516-313-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019552103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist