MEDICARE: DEMAREO MARCUS ASBERRY

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417681172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMAREO MARCUS ASBERRY

Provider Business Mailing Address
First Line	:	PO BOX 30846
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89173-0846
Country	:	US
Telephone Number	:	702-275-5532
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 E AZURE AVE APT 2029
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6875
Country	:	US
Telephone Number	:	702-275-5532
Fax Number	:

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

Provider Enumeration Date	:	07/10/2022
Last Update Date	:	07/10/2022

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Directions to “ DEMAREO MARCUS ASBERRY ” Practice Location

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