Provider Demographics
NPI:1972938553
Name:MCCORMICK, CATHERINE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANN
Other - Last Name:VAN BIBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2270 COLFAX DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2852
Mailing Address - Country:US
Mailing Address - Phone:386-214-4720
Mailing Address - Fax:
Practice Address - Street 1:225 S SWOOPE AVE # 221
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5704
Practice Address - Country:US
Practice Address - Phone:407-662-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW102361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical