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NPI Code Detail

MEDICARE: LISA MARIE MCDERMOTT LCSW-S

MEDICARE: LISA MARIE MCDERMOTT LCSW-S
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
11041C0700XClinical Social Worker57215TX

General Provider Information

NPI Number : 1851696546
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE MCDERMOTT LCSW-S
Provider Business Mailing Address
First Line : 4900 MUELLER BLVD 2 SOUTH
Second Line :
City : AUSTIN
State : TX
Zip : 78723
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4900 MUELLER BLVD 2 SOUTH
Second Line :
City : AUSTIN
State : TX
Zip : 78723-3051
Country : US
Telephone Number : 512-324-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2011
Last Update Date : 03/09/2023

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