MEDICARE: LYDIA JACQUELINE MACCARTHY LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH15768	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346675709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA JACQUELINE MACCARTHY LMHC

Provider Business Mailing Address
First Line	:	PO BOX 9478
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34206-9478
Country	:	US
Telephone Number	:	941-782-4299
Fax Number	:	941-782-4301

Provider Business Practice Location Address
First Line	:	1750 17TH ST STE J2
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-8690
Country	:	US
Telephone Number	:	941-366-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	10/06/2022

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