Provider Demographics
NPI:1427888924
Name:DEMARA, AYMET (LISAC)
Entity type:Individual
Prefix:
First Name:AYMET
Middle Name:
Last Name:DEMARA
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19296 N TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2060
Mailing Address - Country:US
Mailing Address - Phone:520-371-4117
Mailing Address - Fax:
Practice Address - Street 1:8149 N 87TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4352
Practice Address - Country:US
Practice Address - Phone:480-699-9044
Practice Address - Fax:480-739-6116
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)