Provider Demographics
NPI:1275045247
Name:MCDERMOTT, MONICA (CADC, ICADC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:CADC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24776 RIVERS EDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-7221
Mailing Address - Country:US
Mailing Address - Phone:201-562-8735
Mailing Address - Fax:
Practice Address - Street 1:1330 MIDDLEFORD RD STE 303
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3648
Practice Address - Country:US
Practice Address - Phone:302-628-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE050373414OtherFELLOWSHIP HEALTH RESOURCES