Active NPI
Diane McCormack, PH.D.
- Clinical Psychologist
- Grosse Pointe Farms, MI
National Provider Identifier
1376571729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301007909
- Practice address
- 366 Belanger St
Grosse Pointe Farms, MI 48236-3334 - Phone
- (313) 885-1385
- Fax
- (313) 884-6432
- NPI assigned
- Jun 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301007909 | MI | Primary |
Addresses
Primary practice location
366 Belanger St
Grosse Pointe Farms, MI 48236-3334
Mailing address
366 Belanger St
Grosse Pointe Farms, MI 48236-3334
Phone (313) 885-1385
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680H247980 | Other | MI | BCBSM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301007909 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251936000000",
"number": "1376571729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "366 BELANGER ST",
"city": "GROSSE POINTE FARMS",
"state": "MI",
"postal_code": "482363334",
"telephone_number": "313-885-1385",
"fax_number": "313-884-6432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "366 BELANGER ST",
"city": "GROSSE POINTE FARMS",
"state": "MI",
"postal_code": "482363334",
"telephone_number": "313-885-1385",
"fax_number": "313-884-6432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMACK",
"first_name": "DIANE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2009-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301007909",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "680H247980",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grosse Pointe Farms, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.