Provider Demographics
NPI:1689799694
Name:MCCORMICK, ROBERT BARTHOLOMEW (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BARTHOLOMEW
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 LACY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5341
Mailing Address - Country:US
Mailing Address - Phone:336-263-1499
Mailing Address - Fax:
Practice Address - Street 1:2224 LACY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5341
Practice Address - Country:US
Practice Address - Phone:336-263-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0015721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56393OtherBLUE CROSS-BLUE SHIELD
NCE1833-B1172OtherMEDCOST
NC1056663OtherCIGNA PROVIDER ID