Provider Demographics
NPI:1740506468
Name:MCCORMACK, CHARLES C (MA, MSW, LCSW-C)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:MCCORMACK
Suffix:
Gender:M
Credentials:MA, MSW, LCSW-C
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Mailing Address - Street 1:6525 N CHARLES ST
Mailing Address - Street 2:SUITE 239
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6872
Mailing Address - Country:US
Mailing Address - Phone:410-938-8499
Mailing Address - Fax:410-938-4444
Practice Address - Street 1:6525 N CHARLES ST
Practice Address - Street 2:SUITE 239
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6872
Practice Address - Country:US
Practice Address - Phone:410-938-8499
Practice Address - Fax:410-938-4444
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD29201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical