Active NPI
Laura McCormick, PH.D.
- Clinical Psychologist
- San Rafael, CA
National Provider Identifier
1710181441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 17441
- Practice address
- 7 Mount Lassen Dr
Suite C-257
San Rafael, CA 94903-1148 - Phone
- (415) 450-5067
- Fax
- (415) 499-8620
- NPI assigned
- Jun 14, 2007
- Sex
- Female
- Sole proprietor
- No
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 | PSY 17441 | CA | Primary |
Addresses
Primary practice location
7 Mount Lassen Dr
Suite C-257
San Rafael, CA 94903-1148
Mailing address
11 Azalea PL
Novato, CA 94949-7218
Phone (415) 450-5067
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 |
|---|---|---|---|
| PSY 17441 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349049600000",
"number": "1710181441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 AZALEA PL",
"city": "NOVATO",
"state": "CA",
"postal_code": "949497218",
"telephone_number": "415-450-5067",
"fax_number": "415-499-8620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 MOUNT LASSEN DR",
"address_2": "SUITE C-257",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949031148",
"telephone_number": "415-450-5067",
"fax_number": "415-499-8620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "LAURA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-14",
"last_updated": "2012-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 17441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.