Provider Demographics
NPI:1083155105
Name:MCCARTHY, JARED ANDREW (MS, AMFT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ANDREW
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 MERRETT DR APT 2
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-5815
Mailing Address - Country:US
Mailing Address - Phone:619-715-1514
Mailing Address - Fax:
Practice Address - Street 1:4320 EAGLE ROCK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-3211
Practice Address - Country:US
Practice Address - Phone:323-897-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA122229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other