Provider Demographics
NPI:1619710811
Name:MCCARTHY, LISA ANDREA (CPE)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANDREA
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1389
Mailing Address - Country:US
Mailing Address - Phone:518-383-9652
Mailing Address - Fax:
Practice Address - Street 1:12 SWAN DR
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1389
Practice Address - Country:US
Practice Address - Phone:518-383-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other