Provider Demographics
NPI:1376690123
Name:MCCARTHY, MOIRA JEAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:JEAN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR STE 1500
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6923
Mailing Address - Country:US
Mailing Address - Phone:512-453-6555
Mailing Address - Fax:512-347-1119
Practice Address - Street 1:2525 WALLINGWOOD DR STE 1500
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6923
Practice Address - Country:US
Practice Address - Phone:512-453-6555
Practice Address - Fax:512-347-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026LRMedicare UPIN