Provider Demographics
NPI:1316201858
Name:MCCARTHY, KAREN (MS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS
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 536
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-0536
Mailing Address - Country:US
Mailing Address - Phone:845-706-0587
Mailing Address - Fax:
Practice Address - Street 1:504 SOUTHWOODS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7231
Practice Address - Country:US
Practice Address - Phone:845-706-0587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622236051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist