Provider Demographics
NPI:1194151092
Name:DEMCHAK, MARIE (MA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DEMCHAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51913 ANNIE AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7979
Mailing Address - Country:US
Mailing Address - Phone:845-820-0656
Mailing Address - Fax:
Practice Address - Street 1:6 WIERK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2117
Practice Address - Country:US
Practice Address - Phone:845-295-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool