Provider Demographics
NPI:1588659122
Name:MCMAHON, DEENA M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:M
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7036
Mailing Address - Country:US
Mailing Address - Phone:651-224-7771
Mailing Address - Fax:
Practice Address - Street 1:1026 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-7036
Practice Address - Country:US
Practice Address - Phone:651-224-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1032816OtherBEHAVIORAL HEALTHCARE PRO
MN6233653OtherUNITED BEHAVIORAL HEALTH
MN173135OtherUCARE MN
MN705220100Medicaid
HP37572OtherHEALTH PARTNERS
MN223JSMCOtherBCBS