Provider Demographics
NPI:1760878250
Name:MCDERMOTT, MICHELLE L (MS ED BCBA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MS ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4705
Mailing Address - Country:US
Mailing Address - Phone:610-513-0161
Mailing Address - Fax:
Practice Address - Street 1:2695 S JERSEY ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6321
Practice Address - Country:US
Practice Address - Phone:610-513-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-18368103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst