Provider Demographics
NPI:1225030018
Name:MCDERMOTT, ALYSON (MSW)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 PRO-MED LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5323
Mailing Address - Country:US
Mailing Address - Phone:317-587-0567
Mailing Address - Fax:317-574-1230
Practice Address - Street 1:54 N 9TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2236
Practice Address - Country:US
Practice Address - Phone:317-587-0567
Practice Address - Fax:317-574-1230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCADAC II, C679Medicaid