Provider Demographics
NPI:1851737621
Name:MACCORMACK, SHERRI ANN (CASAC T)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:ANN
Last Name:MACCORMACK
Suffix:
Gender:F
Credentials:CASAC T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:154 PARKER HALL ROAD
Mailing Address - Street 2:PO BOX 14
Mailing Address - City:NIVERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12130
Mailing Address - Country:US
Mailing Address - Phone:518-784-3117
Mailing Address - Fax:518-272-6391
Practice Address - Street 1:743 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2266
Practice Address - Country:US
Practice Address - Phone:518-272-3918
Practice Address - Fax:518-272-6391
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)