Provider Demographics
NPI:1063562791
Name:CORMACK, ANNE T (MSW INTERN)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:T
Last Name:CORMACK
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44245 KINGTREE AVE
Mailing Address - Street 2:# 21
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4161
Mailing Address - Country:US
Mailing Address - Phone:661-726-0712
Mailing Address - Fax:
Practice Address - Street 1:1150 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3331
Practice Address - Country:US
Practice Address - Phone:661-951-4076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program