Provider Demographics
NPI:1760833453
Name:MCDERMOTT, JENNIFER ANNE (MED)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 WOODLAND SHORES RD APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2427
Mailing Address - Country:US
Mailing Address - Phone:215-264-9033
Mailing Address - Fax:
Practice Address - Street 1:490 WOODLAND SHORES RD APT B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2427
Practice Address - Country:US
Practice Address - Phone:215-264-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16-8929-038890103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst