Provider Demographics
NPI:1467521617
Name:SMITH MCCORMICK, SHARON (PHD LCSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SMITH MCCORMICK
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819-0327
Mailing Address - Country:US
Mailing Address - Phone:719-687-1145
Mailing Address - Fax:
Practice Address - Street 1:391 RAMPART RANGE RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-2433
Practice Address - Country:US
Practice Address - Phone:719-687-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9770121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC10585Medicare ID - Type Unspecified