Provider Demographics
NPI:1639515232
Name:MCCARTHY, JOANNA (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560
Mailing Address - Country:US
Mailing Address - Phone:914-450-5466
Mailing Address - Fax:
Practice Address - Street 1:205 HARDSCRABBLE RD
Practice Address - Street 2:
Practice Address - City:NORTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10560-1010
Practice Address - Country:US
Practice Address - Phone:914-450-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2015-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5360363LF0000X
NYF337750-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily