Healthcare Provider Details

I. General information

NPI: 1962737015
Provider Name (Legal Business Name): JAMES B MCCORMACK CPC-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 STILLWATER AVENUE ACADIA HOSPITAL CORP.
BANGOR ME
04401
US

IV. Provider business mailing address

P.O. BOX 422 ACADIA HOSPITAL CORP.
BANGOR ME
04402-0422
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6100
  • Fax: 207-973-6109
Mailing address:
  • Phone: 207-973-6100
  • Fax: 207-973-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL3472
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: