Healthcare Provider Details

I. General information

NPI: 1316235385
Provider Name (Legal Business Name): MCCORMICK & ASSOCIATES OF MIDDLETOWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 CARTER DR SUITE B
MIDDLETOWN DE
19709-5846
US

IV. Provider business mailing address

5350 SUMMIT BRIDGE RD SUITE 107
MIDDLETOWN DE
19709-5846
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-0710
  • Fax: 302-449-1770
Mailing address:
  • Phone: 302-449-0710
  • Fax: 302-449-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0000176
License Number StateDE

VIII. Authorized Official

Name: MRS. CAREN COFFY-MCCORMICK
Title or Position: OWNER
Credential: APRN
Phone: 302-449-0710