Provider Demographics
NPI:1205355542
Name:MCCARTHY, JESSICA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DEGAETANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:210 SUMMIT AVE STE C-2A
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1579
Mailing Address - Country:US
Mailing Address - Phone:201-383-5056
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMIT AVE STE C-2A
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1579
Practice Address - Country:US
Practice Address - Phone:201-383-5056
Practice Address - Fax:201-350-8616
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103T00000X
NJ35SI00584600103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist