Healthcare Provider Details

I. General information

NPI: 1982772646
Provider Name (Legal Business Name): MICHELLE PATRICE MCCARTHY MS, CCC-SLP, CEIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 VANDERBILT AVE
NORWOOD MA
02062-5025
US

IV. Provider business mailing address

18 3RD ST
NORWOOD MA
02062-4857
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0405
  • Fax:
Mailing address:
  • Phone: 781-769-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5705
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: