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NPI Code Detail

MEDICARE: HOLLY J MCCORMICK LCSW

MEDICARE: HOLLY J MCCORMICK 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
11041C0700XClinical Social Worker0749221NY

General Provider Information

NPI Number : 1043254303
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY J MCCORMICK LCSW
Provider Business Mailing Address
First Line : 105 LENOX AVE
Second Line :
City : HORSEHEADS
State : NY
Zip : 14845-3105
Country : US
Telephone Number : 607-737-6120
Fax Number :
Provider Business Practice Location Address
First Line : 1019 E WATER ST
Second Line :
City : ELMIRA
State : NY
Zip : 14901-3332
Country : US
Telephone Number : 607-733-5696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 05/31/2011

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