Healthcare Provider Details

I. General information

NPI: 1821056599
Provider Name (Legal Business Name): JANET ELAINE MCDERMOTT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD
FT WAINWRIGHT AK
99703-5001
US

IV. Provider business mailing address

957 WESTBURY DR
ANCHORAGE AK
99503-7056
US

V. Phone/Fax

Practice location:
  • Phone: 907-353-5418
  • Fax:
Mailing address:
  • Phone: 907-333-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number669
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: