Healthcare Provider Details

I. General information

NPI: 1013488964
Provider Name (Legal Business Name): MARY BETH MCDERMOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W FLETCHER AVE
TAMPA FL
33612-3415
US

IV. Provider business mailing address

809 ELMHURST BLVD
SALINA KS
67401-7405
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5300
  • Fax:
Mailing address:
  • Phone: 785-823-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: