Provider Demographics
NPI:1093163107
Name:MCCARTHY, CARRIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1236
Mailing Address - Country:US
Mailing Address - Phone:585-617-9317
Mailing Address - Fax:585-495-1258
Practice Address - Street 1:106 MAIN ST.
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1236
Practice Address - Country:US
Practice Address - Phone:585-617-9317
Practice Address - Fax:585-495-1258
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0647661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04691796Medicaid