Provider Demographics
NPI:1740573609
Name:MCCARTHY, LYN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15119 POWDERHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9421
Mailing Address - Country:US
Mailing Address - Phone:888-667-1181
Mailing Address - Fax:
Practice Address - Street 1:15119 POWDERHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9421
Practice Address - Country:US
Practice Address - Phone:260-414-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst