Provider Demographics
NPI:1134456221
Name:MCCORMICK, CYNTHIA MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MICHELLE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CATON PL
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-1235
Mailing Address - Country:US
Mailing Address - Phone:580-747-7098
Mailing Address - Fax:580-234-0370
Practice Address - Street 1:3421 CATON PL
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-1235
Practice Address - Country:US
Practice Address - Phone:580-747-7098
Practice Address - Fax:580-234-0370
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3452-P104100000X
OK40881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8885473431Medicaid