Provider Demographics
NPI:1497896559
Name:MCCARTHY, MARIANNE CATHLEEN (PHD, NP)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:CATHLEEN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8958 E CONIESON RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7090
Mailing Address - Country:US
Mailing Address - Phone:602-571-2336
Mailing Address - Fax:
Practice Address - Street 1:8958 E CONIESON RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7090
Practice Address - Country:US
Practice Address - Phone:602-571-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3969363LP0808X
AZAP6698363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084734Medicaid