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NPI Code Detail

MEDICARE: MRS. TARA J MCCARTHY RN, FNP, PMHNP

MEDICARE: MRS. TARA J MCCARTHY RN, FNP, PMHNP
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
1163W00000XRegistered Nurse10.071421CT
2163W00000XRegistered Nurse546656NY
3363LF0000XFamily Nurse Practitioner334976NY
4363LP0808XPsychiatric/Mental Health Nurse Practitioner401565NY

Other Identifiers

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

General Provider Information

NPI Number : 1417148842
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA J MCCARTHY RN, FNP, PMHNP
Provider Business Mailing Address
First Line : 400 DOANSBURG RD
Second Line :
City : BREWSTER
State : NY
Zip : 10509-5902
Country : US
Telephone Number : 845-279-2995
Fax Number : 845-279-3024
Provider Business Practice Location Address
First Line : 400 DOANSBURG RD
Second Line :
City : BREWSTER
State : NY
Zip : 10509-5902
Country : US
Telephone Number : 845-279-2995
Fax Number : 845-279-3024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2007
Last Update Date : 07/27/2021

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