Provider Demographics
NPI:1407618879
Name:MCCORMICK, BETHANY ANN (LSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 STONEYBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9372
Mailing Address - Country:US
Mailing Address - Phone:614-805-6090
Mailing Address - Fax:
Practice Address - Street 1:5701 N HIGH ST STE 308
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3960
Practice Address - Country:US
Practice Address - Phone:614-406-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.24102541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical