Provider Demographics
NPI:1104973718
Name:MCCORRY, EDWARD WILLIAM (LCSWR, BCD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:MCCORRY
Suffix:
Gender:M
Credentials:LCSWR, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STANLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2606
Mailing Address - Country:US
Mailing Address - Phone:518-786-0663
Mailing Address - Fax:518-786-0917
Practice Address - Street 1:8 STANLEY CIR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2606
Practice Address - Country:US
Practice Address - Phone:518-786-0663
Practice Address - Fax:518-786-0917
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054636-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical