Provider Demographics
NPI:1710009279
Name:MACMAHON, RICK K (LCSW)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:K
Last Name:MACMAHON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 BROOKHOLLOW DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5455
Mailing Address - Country:US
Mailing Address - Phone:714-436-0590
Mailing Address - Fax:714-436-0589
Practice Address - Street 1:1538 BROOKHOLLOW DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5455
Practice Address - Country:US
Practice Address - Phone:714-436-0590
Practice Address - Fax:714-436-0589
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS7910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW7910Medicare ID - Type UnspecifiedSOCIAL WORKER