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General NPI Number Information
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NPI Number | 1114893773
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Entity Type | Individual
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Provider Name | LISA L MCDERMOTT
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Gender | Female
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 13 CROW HILL RD
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City | UNCASVILLE
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State | CT
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Zip | 06382-1118
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Country | US
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Telephone | 860-862-6302
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GEORGE ST
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City | CROMWELL
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State | CT
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Zip | 06416-1627
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Country | US
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Telephone | 868-609-9595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 16082
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License Number State | CT
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