Provider Demographics
NPI:1427417096
Name:MCCARTHA, WILCOLA (BS)
Entity Type:Individual
Prefix:
First Name:WILCOLA
Middle Name:
Last Name:MCCARTHA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4662 CEPEDA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4822
Mailing Address - Country:US
Mailing Address - Phone:407-535-2868
Mailing Address - Fax:407-270-6686
Practice Address - Street 1:4662 CEPEDA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-4822
Practice Address - Country:US
Practice Address - Phone:407-535-2868
Practice Address - Fax:407-270-6686
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013630400Medicaid