Provider Demographics
NPI:1891145256
Name:MCCORMICK, JULIA MARIE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ARGUELLO BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1453
Mailing Address - Country:US
Mailing Address - Phone:925-628-4417
Mailing Address - Fax:
Practice Address - Street 1:303 ARGUELLO BLVD APT 101
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1453
Practice Address - Country:US
Practice Address - Phone:925-628-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96116104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477026334Medicaid