Individual
MR. BRIAN KENNETH MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1133 BROADWAY, SUITE 540, NEW YORK, NY 10010
(212) 560-7103
Mailing address
248 BARD AVENUE #2, STATEN ISLAND, NY 10310-1660
(212) 560-7103
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
058633
NY
Other
Enumeration date
03/30/2016
Last updated
03/30/2016
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