Healthcare Provider Details

I. General information

NPI: 1093687170
Provider Name (Legal Business Name): THERESE MCCARTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E CHESTNUT ST
AUGUSTA ME
04330-5736
US

IV. Provider business mailing address

109 W FRONT ST
SKOWHEGAN ME
04976-1165
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1561
  • Fax:
Mailing address:
  • Phone: 207-416-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP251760
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: