Provider Demographics
NPI:1760961544
Name:MCCARTHY, ELIZABETH RETTIG (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RETTIG
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1328
Mailing Address - Country:US
Mailing Address - Phone:917-648-0767
Mailing Address - Fax:
Practice Address - Street 1:21 QUEEN ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2509
Practice Address - Country:US
Practice Address - Phone:617-825-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1178841041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool