Provider Demographics
NPI:1518022284
Name:MCCORMICK, MERCEDES ANITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:ANITA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HUDSON ST
Mailing Address - Street 2:APT. 2810 EAST
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6575
Mailing Address - Country:US
Mailing Address - Phone:917-363-7250
Mailing Address - Fax:
Practice Address - Street 1:32 GRAMERCY PARK S
Practice Address - Street 2:SUTIE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1707
Practice Address - Country:US
Practice Address - Phone:917-363-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014540-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014540-1OtherPSYCHOLOGIST