Provider Demographics
NPI:1841015880
Name:MCCARTHY, BRENDAN MICHAEL
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:MICHAEL
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 1:118 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1927
Mailing Address - Country:US
Mailing Address - Phone:585-719-5439
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 767
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-0610
Practice Address - Country:US
Practice Address - Phone:508-386-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW039481041C0700X
NY119058-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker