Provider Demographics
NPI:1225621683
Name:MCCARTHY, LIBERTY JEAN
Entity Type:Individual
Prefix:
First Name:LIBERTY
Middle Name:JEAN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16461 SE CARSON CORNER CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4667
Mailing Address - Country:US
Mailing Address - Phone:503-545-4685
Mailing Address - Fax:
Practice Address - Street 1:1607 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4291
Practice Address - Country:US
Practice Address - Phone:971-233-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician