Provider Demographics
NPI:1346743325
Name:MCDERMOTT, OLIVIA (BS, RBT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9755 LINCOLN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3334
Mailing Address - Country:US
Mailing Address - Phone:916-363-6103
Mailing Address - Fax:
Practice Address - Street 1:9755 LINCOLN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3334
Practice Address - Country:US
Practice Address - Phone:916-363-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-16-12587106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician