MEDICARE: DR. CAROLE ANN DEMARCO PHD

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	103T00000X	Psychologist	PY00002806	WA

General Provider Information

NPI Number	:	1649254061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLE ANN DEMARCO PHD

Provider Business Mailing Address
First Line	:	4423 POINT FOSDICK DR NW
Second Line	:	STE 200
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1794
Country	:	US
Telephone Number	:	206-300-5016
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 POINT FOSDICK DR NW
Second Line	:	SUITE 302
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-851-3808
Fax Number	:	253-851-3188

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	04/18/2016

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