Provider Demographics
NPI:1124485750
Name:MCCARTHY, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 CHIPPEWA SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4834
Mailing Address - Country:US
Mailing Address - Phone:906-228-4050
Mailing Address - Fax:906-228-2153
Practice Address - Street 1:706 CHIPPEWA SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4834
Practice Address - Country:US
Practice Address - Phone:906-228-4050
Practice Address - Fax:906-228-2153
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health