Provider Demographics
NPI:1437559077
Name:MCCARTHY, L. COLLEEN (MS)
Entity Type:Individual
Prefix:MS
First Name:L. COLLEEN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:COLLEEN
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-4189
Practice Address - Street 1:200 HOOSIER DR STE E
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-9349
Practice Address - Country:US
Practice Address - Phone:260-624-3741
Practice Address - Fax:260-624-3744
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000164A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist