Provider Demographics
NPI:1568552867
Name:MCCORMICK, KATHLEEN ANN (MSW, LCSW-C, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MCCORMICK, LCSW, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW-C, LCSW
Mailing Address - Street 1:26084 GOVERNOR STOCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2566
Mailing Address - Country:US
Mailing Address - Phone:302-855-9833
Mailing Address - Fax:302-351-3984
Practice Address - Street 1:26084 GOVERNOR STOCKLEY RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2566
Practice Address - Country:US
Practice Address - Phone:302-855-9833
Practice Address - Fax:302-351-3984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007141041C0700X
MD108541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2637102000OtherMAGELLAN
DE1000035633Medicaid
DE247328OtherCOMPSYCH
DE490718Medicare ID - Type Unspecified