Provider Demographics
NPI:1326584350
Name:MCDERMOTT, KYLE JORDAN
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JORDAN
Last Name:MCDERMOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-6309
Mailing Address - Country:US
Mailing Address - Phone:609-567-0200
Mailing Address - Fax:
Practice Address - Street 1:238 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1108
Practice Address - Country:US
Practice Address - Phone:856-935-7711
Practice Address - Fax:856-935-9123
Is Sole Proprietor?:No
Enumeration Date:2017-01-14
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health