Provider Demographics
NPI:1932242344
Name:MCCORMICK, RENEE VERONICA (PHD, CASAC)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:VERONICA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PHD, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 E 98TH ST
Mailing Address - Street 2:APT 2BC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6518
Mailing Address - Country:US
Mailing Address - Phone:212-982-1742
Mailing Address - Fax:
Practice Address - Street 1:16 E 98TH ST
Practice Address - Street 2:APT 2BC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6518
Practice Address - Country:US
Practice Address - Phone:212-982-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3207101YA0400X
NY006698-1103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3207OtherC.A.S.A.C.
NY006698-1OtherPSYCHOLOGIST