Provider Demographics
NPI:1558499970
Name:MCCARTHY, PAMELA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 LICKING PIKE
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2912
Mailing Address - Country:US
Mailing Address - Phone:859-441-2100
Mailing Address - Fax:859-441-2111
Practice Address - Street 1:519 LICKING PIKE
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071-2912
Practice Address - Country:US
Practice Address - Phone:859-441-2100
Practice Address - Fax:859-441-2111
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100052540Medicaid
KY7100058610Medicaid
KY610661458OtherTAX ID