Provider Demographics
NPI:1063014975
Name:MCCARRICK, KATHLEEN VERONICA
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VERONICA
Last Name:MCCARRICK
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 1:35865 SHETLAND HLS E
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-6519
Mailing Address - Country:US
Mailing Address - Phone:484-431-7678
Mailing Address - Fax:
Practice Address - Street 1:315 N CLEMENTINE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2806
Practice Address - Country:US
Practice Address - Phone:760-433-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW969851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty