Healthcare Provider Details

I. General information

NPI: 1689819203
Provider Name (Legal Business Name): AMY ADELA MCCORMICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 MONROE ST STE 1
EUGENE OR
97402-5176
US

IV. Provider business mailing address

1508 BAR M DR UNIT A
EUGENE OR
97401-6998
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-6843
  • Fax:
Mailing address:
  • Phone: 541-520-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4216
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: