MEDICARE: MAUREEN ELEONORA MCCORMICK PH.D.

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	103T00000X	Psychologist	7912	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2153512	OTHER	MA	CIGNA BEHAVIORAL HEALTH
2	7224414	OTHER	MA	AETNA HEALTH CARE
3	409535	OTHER	MA	TUFTS PPO
4	W06095	OTHER	MA	BCBS OF MASSACHUSETTS

General Provider Information

NPI Number	:	1043364045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN ELEONORA MCCORMICK PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 440315
Second Line	:
City	:	WEST SOMERVILLE
State	:	MA
Zip	:	02144-0027
Country	:	US
Telephone Number	:	617-970-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BEACON ST
Second Line	:	STE 203
City	:	BROOKLINE
State	:	MA
Zip	:	02446-3202
Country	:	US
Telephone Number	:	617-970-3275
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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Directions to “ MAUREEN ELEONORA MCCORMICK PH.D.” Practice Location

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