Provider Demographics
NPI:1952004079
Name:MCCORMAC, ERIN GRACE (CTRS)
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:GRACE
Last Name:MCCORMAC
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2317
Mailing Address - Country:US
Mailing Address - Phone:267-292-9322
Mailing Address - Fax:
Practice Address - Street 1:1425 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2317
Practice Address - Country:US
Practice Address - Phone:267-292-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist