Provider Demographics
NPI:1467859058
Name:MCCARTHY, LAURA MARIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 GREENWAY CT
Mailing Address - Street 2:APT. 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2564
Mailing Address - Country:US
Mailing Address - Phone:571-722-6450
Mailing Address - Fax:
Practice Address - Street 1:12103 GREENWAY CT
Practice Address - Street 2:APT. 101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2564
Practice Address - Country:US
Practice Address - Phone:571-722-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001226381163W00000X
VAL-49236163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant