Provider Demographics
NPI:1215186176
Name:MCCARTHY, SUSAN ANNE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1850
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-1850
Mailing Address - Country:US
Mailing Address - Phone:845-339-6683
Mailing Address - Fax:845-339-7863
Practice Address - Street 1:918 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1344
Practice Address - Country:US
Practice Address - Phone:845-339-6683
Practice Address - Fax:845-339-7863
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362295163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337249OtherMEDICARE
NY01078679Medicaid