Individual
MARY EILEEN MCCARTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
3652 W 111TH ST, CHICAGO, IL 60655-3333
(773) 253-9856
Mailing address
3652 W 111TH ST, CHICAGO, IL 60655-3333
(773) 253-9856
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
MM42931009P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MM42931009P
ILLINOIS DEPARTMENT OF HUMAN SERVICES PART C EARLY INTERVENTION CREDENTIAL
IL
Enumeration date
11/05/2009
Last updated
11/05/2009
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