Basic Information
Provider Information | |||||||||
NPI: | 1215157250 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCCARTHY | ||||||||
FirstName: | KATHLEEN | ||||||||
MiddleName: | MAURA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S.W., L.I.C.S.W. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROWE | ||||||||
OtherFirstName: | KATHLEEN | ||||||||
OtherMiddleName: | MAURA | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.S.W., L.I.C.S.W. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 103 JOHNSON ST | ||||||||
Address2: |   | ||||||||
City: | LYNN | ||||||||
State: | MA | ||||||||
PostalCode: | 019024001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7815932727 | ||||||||
FaxNumber: | 7815932542 | ||||||||
Practice Location | |||||||||
Address1: | 103 JOHNSON ST | ||||||||
Address2: |   | ||||||||
City: | LYNN | ||||||||
State: | MA | ||||||||
PostalCode: | 019024001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7815932727 | ||||||||
FaxNumber: | 7815932542 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1027444 | MA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.