Provider Demographics
NPI:1962990705
Name:MARCHESE, DANA (PHD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LORETTA WAY
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-3041
Mailing Address - Country:US
Mailing Address - Phone:443-807-0886
Mailing Address - Fax:
Practice Address - Street 1:828 DULANEY VALLEY RD STE 11
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2822
Practice Address - Country:US
Practice Address - Phone:410-823-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06016103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool