Provider Demographics
NPI:1205220308
Name:MCDERMOTT, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ROSEMARY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3238
Mailing Address - Country:US
Mailing Address - Phone:314-775-7230
Mailing Address - Fax:
Practice Address - Street 1:145 ROSEMARY ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3238
Practice Address - Country:US
Practice Address - Phone:314-775-7230
Practice Address - Fax:781-400-5839
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist