Individual
ANITA MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
713 S PRAIRIE ST, APT 5, CUBA, MO 65453-1547
(573) 885-0800
(573) 885-1600
Mailing address
713 S PRAIRIE ST, APT 5, CUBA, MO 65453-1547
(573) 885-0800
(573) 885-1600
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2005031753
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891830477
—
MO
01
—
MA3202
MEDICARE PTAN - ORGANIZATION
MO
01
—
MA3202001
MEDICARE PTAN - INDIVIDUAL
MO
Enumeration date
02/21/2007
Last updated
04/27/2011
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