Provider Demographics
NPI:1225035744
Name:MCCORMICK, ALLEN SERGIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:SERGIO
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 BRICKYARD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7239
Mailing Address - Country:US
Mailing Address - Phone:561-966-3071
Mailing Address - Fax:
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6275
Practice Address - Country:US
Practice Address - Phone:561-236-5083
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3546OtherLCSW #
FLU1148Medicare UPIN