MEDICARE: LAURA MARIE MCCARTHY RN, IBCLC

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	101Y00000X	Counselor		VA
2	163W00000X	Registered Nurse	0001226381	VA
3	163WL0100X	Lactation Consultant (Registered Nurse)	L-49236	VA
4	163WC0400X	Case Management Registered Nurse	0001226381	VA

General Provider Information

NPI Number	:	1467859058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE MCCARTHY RN, IBCLC

Provider Business Mailing Address
First Line	:	12103 GREENWAY CT
Second Line	:	APT. 101
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2564
Country	:	US
Telephone Number	:	571-722-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	12103 GREENWAY CT
Second Line	:	APT. 101
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2564
Country	:	US
Telephone Number	:	571-722-6450
Fax Number	:

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

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	06/02/2026

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