Provider Demographics
NPI:1659769883
Name:MCCORMICK, KATHRYN (MSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
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 1:5211 JASMINE TRACE LANE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758
Mailing Address - Country:US
Mailing Address - Phone:407-460-3032
Mailing Address - Fax:
Practice Address - Street 1:5211 JASMINE TRACE LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-1932
Practice Address - Country:US
Practice Address - Phone:407-460-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical