Provider Demographics
NPI:1457475642
Name:MCDERMOTT, PATRICIA (LCPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 VANDALIA ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4859
Mailing Address - Country:US
Mailing Address - Phone:618-345-7424
Mailing Address - Fax:
Practice Address - Street 1:2105 VANDALIA ST
Practice Address - Street 2:SUITE 19
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4859
Practice Address - Country:US
Practice Address - Phone:618-345-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional