Provider Demographics
NPI:1336461813
Name:MCCARTHY, BRIAN J (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
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Mailing Address - Street 1:3713 UNIVERSITY DR
Mailing Address - Street 2:B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6202
Mailing Address - Country:US
Mailing Address - Phone:919-401-6212
Mailing Address - Fax:919-401-4170
Practice Address - Street 1:1015 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3025
Practice Address - Country:US
Practice Address - Phone:503-413-8938
Practice Address - Fax:503-413-6380
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCMSL214785NC163W00000X
MN8270363LP0808X
AZAP9700363LP0808X
OR202102494NP-PP363LP0808X
WI10886-33363LP0808X
NC214786363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse