Healthcare Provider Details

I. General information

NPI: 1184144602
Provider Name (Legal Business Name): MATTHEW J MCCARTHY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 CASCADE RD SE STE 3
GRAND RAPIDS MI
49546-8384
US

IV. Provider business mailing address

4234 CASCADE RD SE STE 3
GRAND RAPIDS MI
49546-8384
US

V. Phone/Fax

Practice location:
  • Phone: 231-590-0562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: