Provider Demographics
NPI:1023209806
Name:DEMARCO, BRANDEN ANGELO (EDS)
Entity Type:Individual
Prefix:MR
First Name:BRANDEN
Middle Name:ANGELO
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HANCOCK ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-758-6871
Mailing Address - Fax:928-758-6834
Practice Address - Street 1:1004 HANCOCK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-758-6871
Practice Address - Fax:928-758-6834
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool