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NPI Code Detail

MEDICARE: JILL ANN MCCORMACK LMSW

MEDICARE: JILL ANN MCCORMACK LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801058799MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730483850
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL ANN MCCORMACK LMSW
Provider Business Mailing Address
First Line : 19750 BURT RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-2078
Country : US
Telephone Number : 313-977-9550
Fax Number : 313-693-9721
Provider Business Practice Location Address
First Line : 19750 BURT RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-2078
Country : US
Telephone Number : 313-977-9550
Fax Number : 313-693-9721
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2011
Last Update Date : 07/25/2022

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