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General NPI Number Information
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NPI Number | 1134577885
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Entity Type | Individual
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Provider Name | JILLIAN MARIE MCCARTHY LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 2111 12 MILE RD NW
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City | SPARTA
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State | MI
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Zip | 49345-9754
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Country | US
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Telephone | 616-391-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE # MC845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801105984
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License Number State | MI
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