Healthcare Provider Details

I. General information

NPI: 1417148842
Provider Name (Legal Business Name): TARA J MCCARTHY RN, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DOANSBURG RD
BREWSTER NY
10509-5902
US

IV. Provider business mailing address

400 DOANSBURG RD
BREWSTER NY
10509-5902
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-2995
  • Fax: 845-279-3024
Mailing address:
  • Phone: 845-279-2995
  • Fax: 845-279-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.071421
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number546656
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334976
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401565
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: