Provider Demographics
NPI:1538258447
Name:MCDERMITT, DEBBIE KAY (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:KAY
Last Name:MCDERMITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 W ALTGELD ST
Mailing Address - Street 2:APT. #3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1081
Mailing Address - Country:US
Mailing Address - Phone:847-344-3928
Mailing Address - Fax:773-252-8874
Practice Address - Street 1:2755 W LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1869
Practice Address - Country:US
Practice Address - Phone:773-486-3797
Practice Address - Fax:773-252-8874
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212588Medicare ID - Type Unspecified