Provider Demographics
NPI:1073531075
Name:MCDERMOTT, GEORGE WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:MCDERMOTT
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 1:115 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4358
Mailing Address - Country:US
Mailing Address - Phone:732-458-6748
Mailing Address - Fax:
Practice Address - Street 1:115 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4358
Practice Address - Country:US
Practice Address - Phone:732-458-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV397H1OtherEMPIRE BC/BS
NJ7769008Medicaid
NJ1080175OtherBC/BS OF NJ
NJ35S100366500OtherLICENSE
NJP3304352OtherOXFORD INSURANCE
NJ0007452233OtherAETNA
NJ7769008Medicaid