Provider Demographics
NPI:1013223981
Name:DEMOREST, DEIRDRE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:MARY
Last Name:DEMOREST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 HOMESTEAD RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4783
Mailing Address - Country:US
Mailing Address - Phone:408-246-1100
Mailing Address - Fax:408-984-0135
Practice Address - Street 1:1588 HOMESTEAD RD
Practice Address - Street 2:SUITE 6
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4783
Practice Address - Country:US
Practice Address - Phone:408-246-1100
Practice Address - Fax:408-984-0135
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical