Provider Demographics
NPI:1245339225
Name:MCCRORY, MARTHA M (LICSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 W GRANDRIDGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7146
Mailing Address - Country:US
Mailing Address - Phone:509-946-9715
Mailing Address - Fax:509-946-9765
Practice Address - Street 1:8045 W GRANDRIDGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7146
Practice Address - Country:US
Practice Address - Phone:509-735-1221
Practice Address - Fax:509-735-5364
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health