MEDICARE: MR. ALLEN SERGIO 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
1	1041C0700X	Clinical Social Worker	3546	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3546	OTHER	FL	LCSW #

General Provider Information

NPI Number	:	1225035744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN SERGIO MCCORMICK LCSW

Provider Business Mailing Address
First Line	:	7160 BRICKYARD CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7239
Country	:	US
Telephone Number	:	561-966-3071
Fax Number	:

Provider Business Practice Location Address
First Line	:	4362 NORTHLAKE BLVD
Second Line	:	SUITE 202
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6275
Country	:	US
Telephone Number	:	561-236-5083
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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