Provider Demographics
NPI:1184902207
Name:CORMIER, ANNE MARIE (MSW LSW MDIV)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:MSW LSW MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1698
Mailing Address - Country:US
Mailing Address - Phone:610-323-1174
Mailing Address - Fax:
Practice Address - Street 1:61 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1698
Practice Address - Country:US
Practice Address - Phone:610-323-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
PASW007093L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral