Provider Demographics
NPI:1407629280
Name:MCCARTHY, SAHR AMUSA
Entity Type:Individual
Prefix:
First Name:SAHR
Middle Name:AMUSA
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 LOTUS POND WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4341
Mailing Address - Country:US
Mailing Address - Phone:916-642-7800
Mailing Address - Fax:
Practice Address - Street 1:5116 LOTUS POND WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-4341
Practice Address - Country:US
Practice Address - Phone:916-642-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37245167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician