Provider Demographics
NPI:1457496523
Name:MCCARTY, MAUREEN M (LICSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:M
Other - Last Name:HOMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:122 W SOUTH ST
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-0209
Mailing Address - Country:US
Mailing Address - Phone:608-637-2511
Mailing Address - Fax:608-637-7921
Practice Address - Street 1:525 NO PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-0525
Practice Address - Country:US
Practice Address - Phone:608-326-2384
Practice Address - Fax:608-637-7921
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24041231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39299300Medicaid
WI39299300Medicaid