Provider Demographics
NPI:1083314165
Name:MCCARTHY, BRENDAN (RBT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S BIRCH RD APT 505
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1521
Mailing Address - Country:US
Mailing Address - Phone:561-674-8651
Mailing Address - Fax:
Practice Address - Street 1:4764 NW 5TH CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9347
Practice Address - Country:US
Practice Address - Phone:561-600-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid