Provider Demographics
NPI:1922739853
Name:MCCORMICK, SERENA (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CORTE PASILLO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6814
Mailing Address - Country:US
Mailing Address - Phone:949-291-1154
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2764
Practice Address - Country:US
Practice Address - Phone:949-373-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist