Provider Demographics
NPI:1922030626
Name:MCCARTHY, GARY JOSEPH (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:JOSEPH
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 HIGHWAY NN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-8215
Mailing Address - Country:US
Mailing Address - Phone:636-485-7851
Mailing Address - Fax:
Practice Address - Street 1:998 E GANNON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2663
Practice Address - Country:US
Practice Address - Phone:636-931-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030005721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO758449805Medicaid
MO815204188Medicare ID - Type UnspecifiedPROVIDER NUMBER