Provider Demographics
NPI:1235528928
Name:MCDERMOTT, DORIS THIBODEAU
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:THIBODEAU
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 1:4 WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-4113
Mailing Address - Country:US
Mailing Address - Phone:203-746-5539
Mailing Address - Fax:
Practice Address - Street 1:4 WOODS WAY
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-4113
Practice Address - Country:US
Practice Address - Phone:203-746-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY404171921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist