Basic Information
| Provider Information | |||||||||
| NPI: | 1548531155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARRY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | CL # 4655 | ||||||||
| Address2: | PO BOX 95000 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191954655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446020 | ||||||||
| FaxNumber: | 8452561881 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 E 168TH ST # 98 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104527929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182933900 | ||||||||
| FaxNumber: | 7182933980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 004611 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.