Provider Demographics
NPI:1316235385
Name:MCCORMICK & ASSOCIATES OF MIDDLETOWN, LLC
Entity type:Organization
Organization Name:MCCORMICK & ASSOCIATES OF MIDDLETOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFY-MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:302-449-0710
Mailing Address - Street 1:5350 SUMMIT BRIDGE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5846
Mailing Address - Country:US
Mailing Address - Phone:302-449-0710
Mailing Address - Fax:302-449-1770
Practice Address - Street 1:292 CARTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5846
Practice Address - Country:US
Practice Address - Phone:302-449-0710
Practice Address - Fax:302-449-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000176364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty