Active NPI
Timothy McMahon, LCSW, SAC-IT
- Clinical Social Worker
- Little Chute, WI
National Provider Identifier
1972209872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9396-123
- Practice address
- 900 Wisconsin CT
Little Chute, WI 54140-2246 - Phone
- (920) 205-0088
- NPI assigned
- Feb 1, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 20042-130 | WI | |
| Clinical Social Worker | 1041C0700X | 9396-123 | WI | Primary |
Addresses
Primary practice location
900 Wisconsin CT
Little Chute, WI 54140-2246
Mailing address
900 Wisconsin CT
Little Chute, WI 54140-2246
Phone (920) 205-0088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20042-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 9396-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1972209872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 WISCONSIN CT",
"city": "LITTLE CHUTE",
"state": "WI",
"postal_code": "541402246",
"telephone_number": "920-205-0088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 WISCONSIN CT",
"city": "LITTLE CHUTE",
"state": "WI",
"postal_code": "541402246",
"telephone_number": "920-205-0088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMAHON",
"first_name": "TIMOTHY",
"credential": "LCSW, SAC-IT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-01",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "20042-130",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "9396-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Chute, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.