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Individual

JENNIFER L MCCORMACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 533-9165
(401) 533-9105
Mailing address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 533-9165
(401) 533-9105

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0614
NHPRI
RI
05
ES01788
RI
01
SB870
BC RI
RI
Enumeration date
03/23/2022
Last updated
03/23/2022
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