Basic Information
| Provider Information | |||||||||
| NPI: | 1780679639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | SOCIAL WORKER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 881 HUNTERS CREEK DR | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329042159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213734176 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1381 S PATRICK DR | ||||||||
| Address2: | 45TH MEDICAL GROUP | ||||||||
| City: | PATRICK AFB | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329253606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214948234 | ||||||||
| FaxNumber: | 3214941378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 0620691 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.