Provider Demographics
NPI:1356473623
Name:MCCORMICK, STEVEN DOUGLAS (PHD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:DOUGLAS
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:P.O. BOX #2306
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95609
Mailing Address - Country:US
Mailing Address - Phone:916-640-8161
Mailing Address - Fax:916-640-8151
Practice Address - Street 1:2288 AUBURN BLVD.
Practice Address - Street 2:SUITE #101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-640-8161
Practice Address - Fax:916-640-8151
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12990103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
171397200OtherACS