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General NPI Number Information
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NPI Number | 1588891592
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Entity Type | Individual
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Provider Name | MARTIN MCCARTHY JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 708 CHURCH ST SUITE 216
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City | EVANSTON
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State | IL
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Zip | 60201-3875
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Country | US
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Telephone | 847-721-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 129 WELWYN ST
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1151
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Country | US
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Telephone | 847-604-4040
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071.003813
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License Number State | IL
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