Provider Demographics
NPI:1104476902
Name:MACDERMOTT, KRISTIN BISHOP (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BISHOP
Last Name:MACDERMOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BERMUDA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4584
Mailing Address - Country:US
Mailing Address - Phone:970-309-5088
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE SQUARE XING STE 203
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4531
Practice Address - Country:US
Practice Address - Phone:561-771-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0004736101YP2500X
CALMFT102440106H00000X
FL3950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional