MEDICARE: MS. DEBBIE KAY MCDERMITT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1538258447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBBIE KAY MCDERMITT LCSW

Provider Business Mailing Address
First Line	:	3845 W ALTGELD ST
Second Line	:	APT. #3
City	:	CHICAGO
State	:	IL
Zip	:	60647-1081
Country	:	US
Telephone Number	:	847-344-3928
Fax Number	:	773-252-8874

Provider Business Practice Location Address
First Line	:	2755 W LOGAN BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1869
Country	:	US
Telephone Number	:	773-486-3797
Fax Number	:	773-252-8874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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