Provider Demographics
NPI:1144343989
Name:MCCARTHY, ANN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WILSHIRE BLVD
Mailing Address - Street 2:# 134
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1809
Mailing Address - Country:US
Mailing Address - Phone:310-769-5214
Mailing Address - Fax:
Practice Address - Street 1:825 WILSHIRE BLVD
Practice Address - Street 2:# 134
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1809
Practice Address - Country:US
Practice Address - Phone:310-769-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16760103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical