MEDICARE: MR. MICHAEL 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

General Provider Information

NPI Number	:	1457365405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL MCCORMICK LCSW

Provider Business Mailing Address
First Line	:	682 PROSPECT AVE
Second Line	:	# 13 REAR
City	:	HARTFORD
State	:	CT
Zip	:	06105-4238
Country	:	US
Telephone Number	:	860-231-0190
Fax Number	:	860-231-0190

Provider Business Practice Location Address
First Line	:	682 PROSPECT AVE
Second Line	:	# 13 REAR
City	:	HARTFORD
State	:	CT
Zip	:	06105-4238
Country	:	US
Telephone Number	:	860-231-0190
Fax Number	:	860-231-0190

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/01/2013

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