=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164989661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL MCCARTHY, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2019
-----------------------------------------------------
Last Update Date | 02/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12550 BISCAYNE BLVD STE 800
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-479-7068
-----------------------------------------------------
Fax | 786-691-1733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12550 BISCAYNE BLVD STE 800
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-479-7068
-----------------------------------------------------
Fax | 786-691-1733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | MICHAEL BRIAN MCCARTHY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 305-479-7068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------