MEDICARE: MR. MARK RICHARD MCCARTHY MA

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	101YP2500X	Professional Counselor	E-0003902	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202181291	OTHER	OH	TAX INDENTIFICATION NO.
2	791082000	OTHER	OH	MAGELLAN MIS GROUP NUMBER
3	279938000	OTHER	OH	MAGELLAN MIS NUMBER

General Provider Information

NPI Number	:	1962500272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK RICHARD MCCARTHY MA

Provider Business Mailing Address
First Line	:	1847 RED FERN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1425
Country	:	US
Telephone Number	:	614-554-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1847 RED FERN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1425
Country	:	US
Telephone Number	:	614-554-0456
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/20/2025

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