Provider Demographics
NPI:1174113328
Name:MCCARTHY, SEAN ROBERT (MA, LPC INTERN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:ROBERT
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 MONEDA AVE N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-6391
Mailing Address - Country:US
Mailing Address - Phone:503-791-9353
Mailing Address - Fax:
Practice Address - Street 1:2478 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2522
Practice Address - Country:US
Practice Address - Phone:503-485-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health