Provider Demographics
NPI:1275857013
Name:DEMARCO, JACQUELINE MONTE DILLON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MONTE DILLON
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:MONTE
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:111 EDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5335
Mailing Address - Country:US
Mailing Address - Phone:205-568-0534
Mailing Address - Fax:
Practice Address - Street 1:111 EDGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5335
Practice Address - Country:US
Practice Address - Phone:205-568-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1553103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical