Provider Demographics
NPI:1740404441
Name:MCCORMICK, EILEEN (MFT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3614
Mailing Address - Country:US
Mailing Address - Phone:831-429-8350
Mailing Address - Fax:
Practice Address - Street 1:709 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3614
Practice Address - Country:US
Practice Address - Phone:831-429-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#