Provider Demographics
NPI:1497478804
Name:MCCORMICK, SAMANTHA (MSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
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 1:18 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5115
Mailing Address - Country:US
Mailing Address - Phone:508-583-6498
Mailing Address - Fax:508-583-3775
Practice Address - Street 1:18 NEWTON ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5115
Practice Address - Country:US
Practice Address - Phone:508-583-6498
Practice Address - Fax:508-583-3775
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health