Provider Demographics
NPI:1407994882
Name:MCCORMICK, MARIE LOUISE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LOUISE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ERVILLA DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3711
Mailing Address - Country:US
Mailing Address - Phone:914-833-5170
Mailing Address - Fax:
Practice Address - Street 1:1327 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1109
Practice Address - Country:US
Practice Address - Phone:212-996-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0286141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical