=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205355542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA A. MCCARTHY PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 08/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 SUMMIT AVE STE C-2A
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645-1579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-383-5056
-----------------------------------------------------
Fax | 201-350-8616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 SUMMIT AVE STE C-2A
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645-1579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-383-5056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 35SI00584600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------