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General NPI Number Information
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NPI Number | 1326179987
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Entity Type | Organization
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Legal Business Name | MATHEW MCCARTHY, MD, SC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 712 55TH ST
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City | KENOSHA
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State | WI
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Zip | 53140-6506
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Country | US
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Telephone | 262-842-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 5407 8TH AVE
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City | KENOSHA
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State | WI
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Zip | 53140-3715
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Country | US
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Telephone | 262-657-7188
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATHEW SEAN MCCARTHY
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Credential | M.D.
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Telephone | 262-842-0538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 49892
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License Number State | WI
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