Provider Demographics
NPI:1063527273
Name:DEMUTH, NANCY MARWICK (PHD MBA)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARWICK
Last Name:DEMUTH
Suffix:
Gender:F
Credentials:PHD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-763-8144
Mailing Address - Fax:717-763-8195
Practice Address - Street 1:205 GRANDVIEW AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-763-8144
Practice Address - Fax:717-763-8195
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003605L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
33772OtherHIGHMARK
01118801OtherBLUE CROSS