Healthcare Provider Details

I. General information

NPI: 1114044518
Provider Name (Legal Business Name): BARBARA A MCCORMICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 CALLAWAY DR
TRINITY FL
34655-4614
US

IV. Provider business mailing address

9005 CALLAWAY DR
TRINITY FL
34655-4614
US

V. Phone/Fax

Practice location:
  • Phone: 727-937-7900
  • Fax:
Mailing address:
  • Phone: 727-937-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: