Provider Demographics
NPI:1205918380
Name:KATHLEEN MCCORMICK, LCSW, LLC
Entity type:Organization
Organization Name:KATHLEEN MCCORMICK, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-C, LLC
Authorized Official - Phone:302-855-9833
Mailing Address - Street 1:26084 GOVERNOR STOCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2566
Mailing Address - Country:US
Mailing Address - Phone:302-855-9833
Mailing Address - Fax:302-351-3984
Practice Address - Street 1:26084 GOVERNOR STOCKLEY RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2566
Practice Address - Country:US
Practice Address - Phone:302-855-9833
Practice Address - Fax:302-351-3984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108541041C0700X
DEQ1-00007141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty