Provider Demographics
NPI:1811471899
Name:MCCORRY, RACHEL ELIZABETH (LICSW, LMSW-CLINICAL)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:MCCORRY
Suffix:
Gender:F
Credentials:LICSW, LMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2997
Mailing Address - Country:US
Mailing Address - Phone:269-978-8874
Mailing Address - Fax:
Practice Address - Street 1:11280 86TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4510
Practice Address - Country:US
Practice Address - Phone:763-400-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011084391041C0700X
MI68010957051041C0700X
MN488881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68010112609OtherSTATE OF MICHIGAN