Provider Demographics
NPI:1235250531
Name:MCCORMICK, JON (PHD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 UNIVERSITY PL FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4513
Mailing Address - Country:US
Mailing Address - Phone:212-929-5333
Mailing Address - Fax:212-929-5333
Practice Address - Street 1:88 UNIVERSITY PL FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:212-929-5333
Practice Address - Fax:212-929-5333
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008249103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist