Provider Demographics
NPI:1801412663
Name:MCCORMICK, MARY ANNE (MSS, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BALA AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3207
Mailing Address - Country:US
Mailing Address - Phone:610-664-8751
Mailing Address - Fax:
Practice Address - Street 1:1 BALA AVE STE 216
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3207
Practice Address - Country:US
Practice Address - Phone:610-664-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO146781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical