Healthcare Provider Details

I. General information

NPI: 1083806871
Provider Name (Legal Business Name): NICOLE ESTHER MCCARTHY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SHERMAN WAY
RESEDA CA
91335-4631
US

IV. Provider business mailing address

18040 SHERMAN WAY
RESEDA CA
91335-4631
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-1219
  • Fax: 818-758-1336
Mailing address:
  • Phone: 818-758-1219
  • Fax: 818-758-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21680
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: