Provider Demographics
NPI:1457365405
Name:MCCORMICK, MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 PROSPECT AVE
Mailing Address - Street 2:# 13 REAR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4238
Mailing Address - Country:US
Mailing Address - Phone:860-231-0190
Mailing Address - Fax:860-231-0190
Practice Address - Street 1:682 PROSPECT AVE
Practice Address - Street 2:# 13 REAR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4238
Practice Address - Country:US
Practice Address - Phone:860-231-0190
Practice Address - Fax:860-231-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical