Provider Demographics
NPI:1205410891
Name:DEMERECKIS, MOLLY (BCBA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DEMERECKIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:19060 EVERETT BLVD. UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448
Mailing Address - Country:US
Mailing Address - Phone:815-641-9187
Mailing Address - Fax:779-324-5236
Practice Address - Street 1:19060 EVERETT BLVD. UNIT 107
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:815-641-9187
Practice Address - Fax:779-324-5236
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst