Provider Demographics
NPI:1972682524
Name:MCCARTHY, JUSTINE B (LCSW)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:B
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2659 PORTAGE BAY E STE 9
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3050
Mailing Address - Country:US
Mailing Address - Phone:530-220-0679
Mailing Address - Fax:530-219-6572
Practice Address - Street 1:2659 PORTAGE BAY E STE 9
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3050
Practice Address - Country:US
Practice Address - Phone:530-220-0679
Practice Address - Fax:530-219-6572
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 247751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA008012Medicaid