Healthcare Provider Details

I. General information

NPI: 1548531155
Provider Name (Legal Business Name): THOMAS W. MCCARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E 168TH ST # 98
BRONX NY
10452-7929
US

IV. Provider business mailing address

CL # 4655 PO BOX 95000
PHILADELPHIA PA
19195-4655
US

V. Phone/Fax

Practice location:
  • Phone: 718-293-3900
  • Fax: 718-293-3980
Mailing address:
  • Phone: 800-444-6020
  • Fax: 845-256-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: