Basic Information
| Provider Information | |||||||||
| NPI: | 1518276229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | MERRI | ||||||||
| MiddleName: | PEARL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOHR | ||||||||
| OtherFirstName: | MERRI | ||||||||
| OtherMiddleName: | PEARL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 722 15TH ST NW | ||||||||
| Address2: | |||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566012528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187513280 | ||||||||
| FaxNumber: | 2187513298 | ||||||||
| Practice Location | |||||||||
| Address1: | 722 15TH ST NW | ||||||||
| Address2: | |||||||||
| City: | BEMIDJI | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566012528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187513280 | ||||||||
| FaxNumber: | 2187513298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2010 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 25615 | MN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 25615 | MN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.