Healthcare Provider Details

I. General information

NPI: 1831278910
Provider Name (Legal Business Name): JOSEPH CHARLES MCCARTY JR. PH.D., NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 W 9TH ST
UPLAND CA
91786-5949
US

IV. Provider business mailing address

PO BOX 4623
ONTARIO CA
91761-0825
US

V. Phone/Fax

Practice location:
  • Phone: 509-412-2588
  • Fax: 888-307-2105
Mailing address:
  • Phone: 509-412-2588
  • Fax: 888-307-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number26796
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number60934231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: