Provider Demographics
NPI:1639694193
Name:MCDERMOTT, REBECCA (MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 GLENDALOUGH RD
Mailing Address - Street 2:
Mailing Address - City:ERDENHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7809
Mailing Address - Country:US
Mailing Address - Phone:484-832-5921
Mailing Address - Fax:
Practice Address - Street 1:711 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-8114
Practice Address - Country:US
Practice Address - Phone:484-832-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist