Provider Demographics
NPI:1003002676
Name:DEMARIA, DANIELLE L
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:DEMARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 N ACADEMY BLVD
Mailing Address - Street 2:STE. 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3317
Mailing Address - Country:US
Mailing Address - Phone:719-428-8939
Mailing Address - Fax:719-218-9001
Practice Address - Street 1:1322 N ACADEMY BLVD
Practice Address - Street 2:STE. 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3317
Practice Address - Country:US
Practice Address - Phone:719-428-8939
Practice Address - Fax:719-218-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO919106H00000X
CA48122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist