Provider Demographics
NPI:1811173933
Name:DERMODY, PENNY (BS,DS)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:DERMODY
Suffix:
Gender:F
Credentials:BS,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ALLISON AVE
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-6958
Mailing Address - Country:US
Mailing Address - Phone:508-880-0202
Mailing Address - Fax:508-880-2425
Practice Address - Street 1:68 ALLISON AVE
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-6958
Practice Address - Country:US
Practice Address - Phone:508-880-0202
Practice Address - Fax:508-880-2425
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator