MEDICARE: KATHRYN MCCORMIC LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 9100	FL

General Provider Information

NPI Number	:	1003094947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MCCORMIC LCSW

Provider Business Mailing Address
First Line	:	5559 SW CHEROKEE ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-5090
Country	:	US
Telephone Number	:	772-634-6340
Fax Number	:

Provider Business Practice Location Address
First Line	:	5559 SW CHEROKEE ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-5090
Country	:	US
Telephone Number	:	772-634-6340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	08/15/2013

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