Provider Demographics
NPI:1679045421
Name:MCCORMICK, JEAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:HERCEGOVICS MCCORMICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:401 N LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6606
Mailing Address - Country:US
Mailing Address - Phone:815-727-6932
Mailing Address - Fax:
Practice Address - Street 1:401 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6606
Practice Address - Country:US
Practice Address - Phone:815-727-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0006461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical