Provider Demographics
NPI:1942570031
Name:MCCARTHY, JEAN MARIE (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1515
Mailing Address - Country:US
Mailing Address - Phone:860-342-5091
Mailing Address - Fax:
Practice Address - Street 1:850 BOLTON RD
Practice Address - Street 2:UNIT 1085
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-9020
Practice Address - Country:US
Practice Address - Phone:860-486-2817
Practice Address - Fax:860-486-5422
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist