Provider Demographics
NPI:1326587015
Name:MCCORMICK, JOHANINA (PH D)
Entity type:Individual
Prefix:DR
First Name:JOHANINA
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:JOHANINA
Other - Middle Name:MCCORMICK
Other - Last Name:ARANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PH D
Mailing Address - Street 1:J48 AVE ALEJANDRINO
Mailing Address - Street 2:VILLA CLEMENTINA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4612
Mailing Address - Country:US
Mailing Address - Phone:646-300-3399
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE MUNOZ RIVERA
Practice Address - Street 2:SUIT 307
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2603
Practice Address - Country:US
Practice Address - Phone:787-744-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003592103TC0700X
NY019005-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical