Healthcare Provider Details

I. General information

NPI: 1750461844
Provider Name (Legal Business Name): JENNIFER MCCARTHY MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 4TH AVE SUITE 200
SAN DIEGO CA
92103-5704
US

IV. Provider business mailing address

3344 4TH AVE SUITE 200
SAN DIEGO CA
92103-5704
US

V. Phone/Fax

Practice location:
  • Phone: 619-733-7053
  • Fax:
Mailing address:
  • Phone: 619-733-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number472339
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 51606
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number472339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: