Healthcare Provider Details

I. General information

NPI: 1720161599
Provider Name (Legal Business Name): CHRISTINE VIOLA MCCORMICK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W RAMSEY ST # 100
BANNING CA
92220-4448
US

IV. Provider business mailing address

1330 W RAMSEY ST # 100
BANNING CA
92220-4448
US

V. Phone/Fax

Practice location:
  • Phone: 951-849-7142
  • Fax: 951-849-1762
Mailing address:
  • Phone: 951-849-7142
  • Fax: 951-849-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW22316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: