Provider Demographics
NPI:1073601662
Name:MCCARTHY, MARY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-5091
Mailing Address - Country:US
Mailing Address - Phone:307-413-5803
Mailing Address - Fax:
Practice Address - Street 1:1011 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-5091
Practice Address - Country:US
Practice Address - Phone:307-413-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK489101YP2500X
AKCSWS11041041C0700X
UT10144643-35011041C0700X
AK11041041C0700X
WYLCSW-11011041C0700X
GU125106H00000X
IDLCSW-363001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid
AKMH2237Medicaid
AK1020986Medicaid