Provider Demographics
NPI:1437472552
Name:MCCARTHY, ANGELICA DAVISON (DAT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:DAVISON
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2105
Mailing Address - Country:US
Mailing Address - Phone:412-352-1186
Mailing Address - Fax:
Practice Address - Street 1:45 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2105
Practice Address - Country:US
Practice Address - Phone:412-352-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0025732255A2300X
CT0013652255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer