Provider Demographics
NPI:1629552534
Name:MCCARY, MARTIN A (BSW)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:MCCARY
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17956 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2220
Mailing Address - Country:US
Mailing Address - Phone:708-653-7377
Mailing Address - Fax:
Practice Address - Street 1:17956 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2220
Practice Address - Country:US
Practice Address - Phone:708-653-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010371A104100000X
171M00000X
IN34011040A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator