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General NPI Number Information
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NPI Number | 1235567553
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Entity Type | Individual
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Provider Name | JACLYN MCCARTHY
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Gender | Female
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 950 S OYSTER BAY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-3510
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Country | US
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Telephone | 516-396-2896
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BEECHWOOD CT
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2401
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 29439
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 006777
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License Number State | NY
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