Provider Demographics
NPI:1982606786
Name:MCCARTHY, KATHLEEN O (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:O
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:O'BEIRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:100 CUMMINGS CTR STE 324A
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6112
Mailing Address - Country:US
Mailing Address - Phone:978-921-1088
Mailing Address - Fax:978-921-1098
Practice Address - Street 1:100 CUMMINGS CTR STE 324A
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6112
Practice Address - Country:US
Practice Address - Phone:978-921-1088
Practice Address - Fax:978-921-1098
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23300Medicare ID - Type Unspecified