Provider Demographics
NPI:1194962688
Name:MCDERMUT, JENNIFER FINE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FINE
Last Name:MCDERMUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIVEREDGE RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3211
Mailing Address - Country:US
Mailing Address - Phone:201-567-3890
Mailing Address - Fax:
Practice Address - Street 1:30 RIVEREDGE RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3211
Practice Address - Country:US
Practice Address - Phone:201-567-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00382100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical