Provider Demographics
NPI:1174956825
Name:MCCORMICK, CASEY MARIE
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:MARIE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14333 LODGEPOLE DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9574
Mailing Address - Country:US
Mailing Address - Phone:530-432-3813
Mailing Address - Fax:
Practice Address - Street 1:138 NEW MOHAWK RD
Practice Address - Street 2:200
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3244
Practice Address - Country:US
Practice Address - Phone:530-478-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator