Provider Demographics
NPI:1497734867
Name:MCDERMOTT, AMY LOUISE (LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2600
Mailing Address - Country:US
Mailing Address - Phone:904-823-8787
Mailing Address - Fax:904-819-5330
Practice Address - Street 1:2200 N PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2600
Practice Address - Country:US
Practice Address - Phone:904-823-8787
Practice Address - Fax:904-819-5330
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health