Provider Demographics
NPI:1548469596
Name:MCCARTY, JASON PATRICK (PSYD LP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PATRICK
Last Name:MCCARTY
Suffix:
Gender:
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4498
Mailing Address - Country:US
Mailing Address - Phone:320-308-3171
Mailing Address - Fax:203-308-0959
Practice Address - Street 1:720 4TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4498
Practice Address - Country:US
Practice Address - Phone:320-308-3171
Practice Address - Fax:203-308-0959
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical