Basic Information
| Provider Information | |||||||||
| NPI: | 1326058926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDERMOTT | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 307 | ||||||||
| Address2: | JOHNSON PROFESSIONAL ASSOCIATES | ||||||||
| City: | WILBRAHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010950307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085950531 | ||||||||
| FaxNumber: | 5088295367 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 HAZARD AVE SUITE 4 | ||||||||
| Address2: | JOHNSON PROFESSIONAL ASSOCIATES | ||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607638040 | ||||||||
| FaxNumber: | 8607638049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 000302 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.