Provider Demographics
NPI:1093194573
Name:DEMARIA, ANTHONY PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PATRICK
Last Name:DEMARIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E 92ND ST
Mailing Address - Street 2:4RE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5451
Mailing Address - Country:US
Mailing Address - Phone:973-632-8649
Mailing Address - Fax:
Practice Address - Street 1:316 E 92ND ST
Practice Address - Street 2:4RE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5451
Practice Address - Country:US
Practice Address - Phone:973-632-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical