Provider Demographics
NPI:1730053455
Name:MCDERMOTT, CHERYL LEE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 S ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8900
Mailing Address - Country:US
Mailing Address - Phone:812-269-2479
Mailing Address - Fax:
Practice Address - Street 1:600 E HILLSIDE DR STE 3
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6401
Practice Address - Country:US
Practice Address - Phone:812-269-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012407A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker