Provider Demographics
NPI:1104992270
Name:MCCARTHY, KATHLEEN E (LICSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 CENTERCREST DR
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2715
Mailing Address - Country:US
Mailing Address - Phone:978-618-7574
Mailing Address - Fax:978-649-5625
Practice Address - Street 1:234 LITTLETON RD STE 1B
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3530
Practice Address - Country:US
Practice Address - Phone:978-496-8079
Practice Address - Fax:978-649-5625
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305638Medicaid