Provider Demographics
NPI:1235491333
Name:MCCORMICK-DEATON, CATHERINE MONICA (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MONICA
Last Name:MCCORMICK-DEATON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SMITH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2424
Mailing Address - Country:US
Mailing Address - Phone:651-241-5959
Mailing Address - Fax:
Practice Address - Street 1:280 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2424
Practice Address - Country:US
Practice Address - Phone:651-241-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN628582084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry