Provider Demographics
NPI:1497449789
Name:MCCARTHY, KERRY J (LMT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SILVER ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3067
Mailing Address - Country:US
Mailing Address - Phone:413-612-4360
Mailing Address - Fax:413-261-6242
Practice Address - Street 1:200 SILVER ST UNIT 105
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3067
Practice Address - Country:US
Practice Address - Phone:413-612-4360
Practice Address - Fax:413-261-6242
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17303225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist