Provider Demographics
NPI:1932800695
Name:MCDERMOTT, KAREN (CLC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WINANS PL APT B
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1259
Mailing Address - Country:US
Mailing Address - Phone:516-238-9571
Mailing Address - Fax:
Practice Address - Street 1:310 WINANS PL APT B
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1259
Practice Address - Country:US
Practice Address - Phone:516-238-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348330174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN