Healthcare Provider Details

I. General information

NPI: 1023518057
Provider Name (Legal Business Name): HEATHER MCDERMOTT PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 CLIFF RD
PORT AUSTIN MI
48467-9261
US

IV. Provider business mailing address

PO BOX 25052
HONOLULU HI
96825-0052
US

V. Phone/Fax

Practice location:
  • Phone: 808-285-4776
  • Fax:
Mailing address:
  • Phone: 808-285-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER MCDERMOTT
Title or Position: OWNER
Credential: PSYD
Phone: 808-285-4776