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General NPI Number Information
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NPI Number | 1417286972
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES DEMARCO PSY.D., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2009
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 20 E TAUNTON RD STE 540
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City | BERLIN
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State | NJ
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Zip | 08009-2625
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Country | US
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Telephone | 856-809-2940
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Fax | 856-336-2231
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Provider Business Mailing Address
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Address Line | 1151 N 3RD ST UNIT 211
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1575
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Country | US
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Telephone | 570-540-0106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00619500
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License Number State | NJ
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