Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003483546 |
---|---|
Provider Name | Jessica Mcmahon |
First Address | Towaco, NJ 07082-1430 |
Second Address | Towaco, NJ 07082-1430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |