Healthcare Provider Details

I. General information

NPI: 1750488177
Provider Name (Legal Business Name): JENNIFER M. MCCARTHY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 WASHINGTON ST
CONWAY NH
03818-6044
US

IV. Provider business mailing address

PO BOX 2726
CONWAY NH
03818-2726
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-2453
  • Fax: 603-447-2450
Mailing address:
  • Phone: 603-447-2453
  • Fax: 603-447-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1060
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1060
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerLICSW LICENSURE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: