Provider Demographics
NPI:1942661152
Name:MCCARTHY, BERNICE (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 SW PHILOMATH BLVD
Mailing Address - Street 2:PMB 165
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3239
Mailing Address - Country:US
Mailing Address - Phone:541-307-0195
Mailing Address - Fax:
Practice Address - Street 1:404 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5539
Practice Address - Country:US
Practice Address - Phone:541-753-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW 1790101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)