Provider Demographics
NPI:1578746814
Name:JOANN MCDERMOTT, CSW PSYCHOTHERAPY PC
Entity Type:Organization
Organization Name:JOANN MCDERMOTT, CSW PSYCHOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-241-3170
Mailing Address - Street 1:2000 WINTON RD S
Mailing Address - Street 2:BUILDING 4 SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3970
Mailing Address - Country:US
Mailing Address - Phone:585-241-3170
Mailing Address - Fax:585-241-3094
Practice Address - Street 1:2000 WINTON RD S
Practice Address - Street 2:BUILDING 4 SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3970
Practice Address - Country:US
Practice Address - Phone:585-241-3170
Practice Address - Fax:585-241-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041540-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP76409Medicare UPIN