Provider Demographics
NPI:1972395432
Name:MCDERMOTT, LORI (BCBA 1-25-80658)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:BCBA 1-25-80658
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 469
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-0469
Mailing Address - Country:US
Mailing Address - Phone:508-446-4517
Mailing Address - Fax:
Practice Address - Street 1:10 RIVER RD
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569-2259
Practice Address - Country:US
Practice Address - Phone:508-446-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-25-80658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst