Provider Demographics
NPI:1154897536
Name:MCCARTHY, KATHRYN M (LIC AC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2433
Mailing Address - Country:US
Mailing Address - Phone:603-213-3748
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2433
Practice Address - Country:US
Practice Address - Phone:603-213-3748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH246OtherACUPUNCTURE LICENSE