Provider Demographics
NPI:1871784710
Name:MCCRACKEN, JAMES ADAM (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ADAM
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 TOWN PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6206
Mailing Address - Country:US
Mailing Address - Phone:407-695-3664
Mailing Address - Fax:407-695-3674
Practice Address - Street 1:1806 TOWN PLAZA CT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6206
Practice Address - Country:US
Practice Address - Phone:407-695-3664
Practice Address - Fax:407-695-3674
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist