Basic Information
| Provider Information | |||||||||
| NPI: | 1841925591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTY | ||||||||
| FirstName: | MIRANDA | ||||||||
| MiddleName: | EUGENIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 426 JUDY LN | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998011472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073644445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1046 SALMON CREEK LN | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073644445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2022 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 195822 | AK | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.