Provider Demographics
NPI:1013058163
Name:MCCARTY, KRISTIN MARY HERRO (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARY HERRO
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARY
Other - Last Name:HERRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:12912 W GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2639
Mailing Address - Country:US
Mailing Address - Phone:262-754-2743
Mailing Address - Fax:
Practice Address - Street 1:4402 S 68TH ST
Practice Address - Street 2:#100
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3479
Practice Address - Country:US
Practice Address - Phone:414-321-4411
Practice Address - Fax:414-321-0552
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3485-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40919800Medicaid