Provider Demographics
NPI:1538627807
Name:WHITTAKER-MCDERMOTT, BEVERLY V (LCSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:V
Last Name:WHITTAKER-MCDERMOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:V
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3007 E. BIDDLE STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213
Mailing Address - Country:US
Mailing Address - Phone:443-423-5375
Mailing Address - Fax:443-423-5500
Practice Address - Street 1:3007 E. BIDDLE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213
Practice Address - Country:US
Practice Address - Phone:443-423-5375
Practice Address - Fax:443-423-5500
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker