Provider Demographics
NPI:1093834921
Name:MCDERMOTT, MARIE (CSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2104
Mailing Address - Country:US
Mailing Address - Phone:718-788-5005
Mailing Address - Fax:
Practice Address - Street 1:267 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2104
Practice Address - Country:US
Practice Address - Phone:718-788-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN47541Medicare ID - Type UnspecifiedPSYCHOTHERAPY