Provider Demographics
NPI:1558912493
Name:MCCORMICK, MARIE THERESA
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:THERESA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 FOX ST
Mailing Address - Street 2:
Mailing Address - City:DURHAMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13054-3102
Mailing Address - Country:US
Mailing Address - Phone:315-335-7547
Mailing Address - Fax:
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5957
Practice Address - Country:US
Practice Address - Phone:315-724-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator