Provider Demographics
NPI:1043282445
Name:MCCARTHY, JAMIE LEE (APRN)
Entity Type:Individual
Prefix:MS
First Name:JAMIE LEE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CHESTNUT ST
Mailing Address - Street 2:STE 23
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1610
Mailing Address - Country:US
Mailing Address - Phone:413-787-2800
Mailing Address - Fax:413-787-2822
Practice Address - Street 1:1400 COMPUTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1790
Practice Address - Country:US
Practice Address - Phone:617-420-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232684363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4334OtherBLUE CROSS
MA8303928OtherEVERCARE
MA8303928OtherEVERCARE
MAUX2008Medicare PIN
MANP4334OtherBLUE CROSS
MAUX2940Medicare PIN