Provider Demographics
NPI:1629542444
Name:MCCARTHY, REBECCA JILL (HAS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JILL
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WITCHDUCK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1947
Mailing Address - Country:US
Mailing Address - Phone:833-687-8324
Mailing Address - Fax:757-222-5991
Practice Address - Street 1:600 N WITCHDUCK RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1947
Practice Address - Country:US
Practice Address - Phone:833-687-8324
Practice Address - Fax:757-222-5991
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002282237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891289757Medicaid