MEDICARE: DANIELLE L DEMARIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	919	CO
2	106H00000X	Marriage & Family Therapist	48122	CA

General Provider Information

NPI Number	:	1003002676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE L DEMARIA

Provider Business Mailing Address
First Line	:	1322 N ACADEMY BLVD
Second Line	:	STE. 202
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3317
Country	:	US
Telephone Number	:	719-428-8939
Fax Number	:	719-218-9001

Provider Business Practice Location Address
First Line	:	1322 N ACADEMY BLVD
Second Line	:	STE. 202
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3317
Country	:	US
Telephone Number	:	719-428-8939
Fax Number	:	719-218-9001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	08/18/2011

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Directions to “ DANIELLE L DEMARIA ” Practice Location

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