Provider Demographics
NPI:1285459362
Name:MCDERMOTT, JOSEPH LOUIS
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LOUIS
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2926
Mailing Address - Country:US
Mailing Address - Phone:718-541-8018
Mailing Address - Fax:
Practice Address - Street 1:66 WILLOW AVE STE 203
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1829
Practice Address - Country:US
Practice Address - Phone:718-876-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health