Provider Demographics
NPI:1346550068
Name:MCDERMOTT, MARTIN A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:A
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S PROSPECT AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4408
Mailing Address - Country:US
Mailing Address - Phone:310-892-4929
Mailing Address - Fax:
Practice Address - Street 1:3741 STOCKER ST STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5148
Practice Address - Country:US
Practice Address - Phone:323-596-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist