Provider Demographics
NPI:1336204734
Name:MCCARTHY, MARIA LYDIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LYDIA
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LYDIA
Other - Last Name:JOVELLANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 WOODCREST CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1134
Mailing Address - Country:US
Mailing Address - Phone:732-479-0542
Mailing Address - Fax:
Practice Address - Street 1:19 WOODCREST CIR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1134
Practice Address - Country:US
Practice Address - Phone:718-666-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00405500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS9441Medicare UPIN