Provider Demographics
NPI:1457916272
Name:MCDERMOTT, DEBRA JEAN (CP 60476127)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEAN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:CP 60476127
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2313
Mailing Address - Country:US
Mailing Address - Phone:206-242-4915
Mailing Address - Fax:206-242-4975
Practice Address - Street 1:235 SW 153RD ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2313
Practice Address - Country:US
Practice Address - Phone:206-242-4915
Practice Address - Fax:206-242-4975
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60476127101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1710331905OtherPRIVATE CARE
WA60476127OtherPRIVATE CARE