Basic Information
Provider Information | |||||||||
NPI: | 1255406013 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCCARTHY | ||||||||
FirstName: | JEFFREY | ||||||||
MiddleName: | RAYMOND | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 421 NORTH MAIN STREET | ||||||||
Address2: | NORTHAMPTON VA MEDICAL CENTER | ||||||||
City: | LEEDS | ||||||||
State: | MA | ||||||||
PostalCode: | 010539764 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135844040 | ||||||||
FaxNumber: | 4135823121 | ||||||||
Practice Location | |||||||||
Address1: | 25 BOND STREET | ||||||||
Address2: | SPRINGFIELD VA OUTPATIENT CLINIC | ||||||||
City: | SPRINGFIELD | ||||||||
State: | MA | ||||||||
PostalCode: | 011043401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4137316050 | ||||||||
FaxNumber: | 4137884617 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/21/2006 | ||||||||
LastUpdateDate: | 07/15/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 8578 | MA | N |   | Behavioral Health & Social Service Providers | Psychologist |   | 103TC0700X | 8578 | MA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | 8578 | MA | N |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   |
No ID Information.