Provider Demographics
NPI:1487705257
Name:DERMODY, MARY C (LPC,LMFT,NCC,MA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:DERMODY
Suffix:
Gender:F
Credentials:LPC,LMFT,NCC,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 HESPER AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1555
Mailing Address - Country:US
Mailing Address - Phone:504-554-1346
Mailing Address - Fax:504-304-8470
Practice Address - Street 1:1217 HESPER AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-1555
Practice Address - Country:US
Practice Address - Phone:504-554-1346
Practice Address - Fax:504-304-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health