Provider Demographics
NPI:1558092460
Name:MCCRORY, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCCRORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:STAR LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:13690-3143
Mailing Address - Country:US
Mailing Address - Phone:315-848-5404
Mailing Address - Fax:315-848-3285
Practice Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Practice Address - Street 2:
Practice Address - City:STAR LAKE
Practice Address - State:NY
Practice Address - Zip Code:13690-3143
Practice Address - Country:US
Practice Address - Phone:315-848-5404
Practice Address - Fax:315-848-3285
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health