MEDICARE: JENNIFER DEMARCO LPC

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	101200000X	Drama Therapist
2	101YP2500X	Professional Counselor	PC012981	PA

General Provider Information

NPI Number	:	1326354614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DEMARCO LPC

Provider Business Mailing Address
First Line	:	710 WINCHESTER RD
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-3431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 S 23RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3329
Country	:	US
Telephone Number	:	215-468-4673
Fax Number	:

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	04/29/2021

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