Provider Demographics
NPI:1215117015
Name:MCMAHON, ROGER THOMAS (MSSW)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:THOMAS
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 W POLY WEBB RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3615
Mailing Address - Country:US
Mailing Address - Phone:817-478-0095
Mailing Address - Fax:817-478-7628
Practice Address - Street 1:6702 W POLY WEBB RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-3615
Practice Address - Country:US
Practice Address - Phone:817-478-0095
Practice Address - Fax:817-478-7628
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker