Provider Demographics
NPI:1396260444
Name:MCCARTHY, MICHAEL
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1728
Mailing Address - Country:US
Mailing Address - Phone:802-752-7338
Mailing Address - Fax:
Practice Address - Street 1:1500 S SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2831
Practice Address - Country:US
Practice Address - Phone:708-367-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2420043103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool