Provider Demographics
NPI:1780915033
Name:MCCARTHY, COLLEEN MARIE (CSWR(NY 037636) MS)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:CSWR(NY 037636) MS
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:MCARTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW(FL) PSW 723
Mailing Address - Street 1:52 TAO CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-333-6452
Mailing Address - Fax:239-415-8780
Practice Address - Street 1:52 TAO CT
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-333-6452
Practice Address - Fax:239-415-8780
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW7231041C0700X
NY0376361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical