Healthcare Provider Details

I. General information

NPI: 1205512282
Provider Name (Legal Business Name): KATHLEEN MCCARTHY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 DAY DR
CARMICHAEL CA
95608-6008
US

IV. Provider business mailing address

1621 DAY DR
CARMICHAEL CA
95608
US

V. Phone/Fax

Practice location:
  • Phone: 916-628-1168
  • Fax:
Mailing address:
  • Phone: 916-628-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: