Provider Demographics
NPI:1891071742
Name:MCCORMICK, MAUREEN ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10570 NW FLOTOMA DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6225
Mailing Address - Country:US
Mailing Address - Phone:503-201-1216
Mailing Address - Fax:
Practice Address - Street 1:9860 SW HALL BLVD
Practice Address - Street 2:SUITE C2
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8896
Practice Address - Country:US
Practice Address - Phone:503-201-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL30531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical