Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY00001724 | WA |
Y | 103T00000X | Psychologist | PY00001724 | WA |
N | 103G00000X | Clinical Psychologist | PSY13338 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13338 | CA |
N | 103TH0100X | Health Service | PSY13338 | CA |
NPI | 1255406955 |
---|---|
Provider Name | Dr. Michael Christopher Mccormick |
First Address | Daly City, CA 94015-2770 |
Second Address | Daly City, CA 94015-2770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 30/12/2021 |