Provider Demographics
NPI:1962500272
Name:MCCARTHY, MARK RICHARD (MA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RICHARD
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N HIGH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3611
Mailing Address - Country:US
Mailing Address - Phone:614-263-6272
Mailing Address - Fax:614-268-3949
Practice Address - Street 1:3620 N HIGH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3611
Practice Address - Country:US
Practice Address - Phone:614-263-6272
Practice Address - Fax:614-268-3949
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7880655Medicare UPIN
OH000000361617Medicare UPIN