Healthcare Provider Details

I. General information

NPI: 1255406013
Provider Name (Legal Business Name): JEFFREY RAYMOND MCCARTHY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND STREET SPRINGFIELD VA OUTPATIENT CLINIC
SPRINGFIELD MA
01104-3401
US

IV. Provider business mailing address

421 NORTH MAIN STREET NORTHAMPTON VA MEDICAL CENTER
LEEDS MA
01053-9764
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-6050
  • Fax: 413-788-4617
Mailing address:
  • Phone: 413-584-4040
  • Fax: 413-582-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8578
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8578
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8578
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: