=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104992270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN E MCCARTHY LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 08/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 LITTLETON RD STE 1B
-----------------------------------------------------
City | WESTFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01886-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-496-8079
-----------------------------------------------------
Fax | 978-649-5625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 CENTERCREST DR
-----------------------------------------------------
City | TYNGSBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01879-2715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-618-7574
-----------------------------------------------------
Fax | 978-649-5625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 112032
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------