Provider Demographics
NPI:1578674826
Name:MCCORMICK, HARRISON GOODERHAM (MSW BCD)
Entity Type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:GOODERHAM
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 BITLER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756
Mailing Address - Country:US
Mailing Address - Phone:570-546-6250
Mailing Address - Fax:570-546-6250
Practice Address - Street 1:1881 BITLER HILL ROAD
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756
Practice Address - Country:US
Practice Address - Phone:570-546-6250
Practice Address - Fax:570-546-6250
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000966L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10494721049490Medicaid
185811Medicare PIN
PA10494721049490Medicaid