Healthcare Provider Details

I. General information

NPI: 1942321989
Provider Name (Legal Business Name): MASSIMO DE MARCHIS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 BECKMAN ST NOVA HOUSE ASSOCIATION INC.
DAYTON OH
45410-2165
US

IV. Provider business mailing address

2536 ROANOKE AVE
DAYTON OH
45419-1528
US

V. Phone/Fax

Practice location:
  • Phone: 937-253-1680
  • Fax: 937-253-8990
Mailing address:
  • Phone: 937-684-2123
  • Fax: 937-294-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: