MEDICARE: SUZANNE ROSE MCCARTHY LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CC2552	ME
2	101YM0800X	Mental Health Counselor	CC2552	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588611156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE ROSE MCCARTHY LCPC

Provider Business Mailing Address
First Line	:	78 ATLANTIC PLACE
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2316
Country	:	US
Telephone Number	:	207-842-7701
Fax Number	:	207-842-7773

Provider Business Practice Location Address
First Line	:	165 LANCASTER ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-2406
Country	:	US
Telephone Number	:	207-874-1030
Fax Number	:	207-874-1044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/11/2012

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