Healthcare Provider Details

I. General information

NPI: 1194151092
Provider Name (Legal Business Name): MARIE ANN DEMCHAK-BUOTTE PHD, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 FABER PLACE DR STE 110
NORTH CHARLESTON SC
29405-8585
US

IV. Provider business mailing address

51913 ANNIE AVE
PLEASANT VALLEY NY
12569-7979
US

V. Phone/Fax

Practice location:
  • Phone: 833-803-1894
  • Fax:
Mailing address:
  • Phone: 845-820-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2016
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: