Basic Information
| Provider Information | |||||||||
| NPI: | 1417022500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | ANDRE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MHRS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 120 PAGE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941025811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152556544 | ||||||||
| FaxNumber: | 4158642086 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 PAGE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941025811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152556544 | ||||||||
| FaxNumber: | 4158642086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.