Provider Demographics
NPI:1730211871
Name:MCDERMOTT, LORRAINE WEIMORTS (PHD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:WEIMORTS
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1810
Mailing Address - Country:US
Mailing Address - Phone:410-263-5300
Mailing Address - Fax:410-544-1760
Practice Address - Street 1:20 RIDGELY AVE
Practice Address - Street 2:STE. 309
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1410
Practice Address - Country:US
Practice Address - Phone:410-263-5300
Practice Address - Fax:410-544-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1892103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG649Medicare UPIN