MEDICARE: MRS. ALEXANDRA MCDERMOTT PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	NLC.0103563	CO

General Provider Information

NPI Number	:	1528305745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA MCDERMOTT PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 6129
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-0129
Country	:	US
Telephone Number	:	720-485-4194
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S CHERRY ST
Second Line	:	SUITE 230
City	:	DENVER
State	:	CO
Zip	:	80246-1702
Country	:	US
Telephone Number	:	720-485-4194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	09/20/2014

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