MEDICARE: LISA MCCORMICK

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15572300	NJ

General Provider Information

NPI Number	:	1699607556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MCCORMICK

Provider Business Mailing Address
First Line	:	2215 OLD YORK RD
Second Line	:
City	:	BORDENTOWN
State	:	NJ
Zip	:	08505-4617
Country	:	US
Telephone Number	:	609-213-4197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 OLD YORK RD
Second Line	:
City	:	BORDENTOWN
State	:	NJ
Zip	:	08505-4617
Country	:	US
Telephone Number	:	609-213-4197
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ LISA MCCORMICK ” Practice Location

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