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General NPI Number Information
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NPI Number | 1134596992
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Entity Type | Organization
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Legal Business Name | DEVON MACDERMOTT, PSYCHOLOGIST, P.C.
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 80 5TH AVE SUITE 1107
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City | NEW YORK
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State | NY
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Zip | 10011-8002
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Country | US
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Telephone | 201-674-5603
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Fax |
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Provider Business Mailing Address
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Address Line | 100 LEFFERTS AVE APT 6B
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City | BROOKLYN
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State | NY
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Zip | 11225-3948
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Country | US
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Telephone | 201-674-5603
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEVON MACDERMOTT
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Credential | PH.D.
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Telephone | 201-674-5603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 020461
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License Number State | NY
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