Healthcare Provider Details

I. General information

NPI: 1164590170
Provider Name (Legal Business Name): STEVEN PAUL DEMARCO LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 188TH ST 5TH FLOOR
BRONX NY
10458-5302
US

IV. Provider business mailing address

152 THOMPSON ST APARTMENT D
NEW YORK NY
10012-5327
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-0278
  • Fax: 718-933-2502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR052150-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: