Provider Demographics
NPI:1023026820
Name:DEMSHOCK, MARJORIE S (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:S
Last Name:DEMSHOCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 VETERANS HWY
Mailing Address - Street 2:APT. 1F
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1227
Mailing Address - Country:US
Mailing Address - Phone:631-265-0305
Mailing Address - Fax:
Practice Address - Street 1:650 VETERANS HWY
Practice Address - Street 2:APT. 1F
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-1227
Practice Address - Country:US
Practice Address - Phone:631-265-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000576-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health