Provider Demographics
NPI:1881825669
Name:MCDERMOTT, HANA IBRAHIMOVIC
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:IBRAHIMOVIC
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VOORHEES AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2341
Mailing Address - Country:US
Mailing Address - Phone:310-429-4309
Mailing Address - Fax:
Practice Address - Street 1:2000 VOORHEES AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2341
Practice Address - Country:US
Practice Address - Phone:310-429-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist