Provider Demographics
NPI:1154588283
Name:MCCARTHY, JENNIFER B (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARSONSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04047-0777
Mailing Address - Country:US
Mailing Address - Phone:207-625-8126
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:ME
Practice Address - Zip Code:04068-3527
Practice Address - Country:US
Practice Address - Phone:207-625-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC4146OtherLCPC