Provider Demographics
NPI:1326779299
Name:DEMARCO, ELIZABETH A (BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1228
Mailing Address - Country:US
Mailing Address - Phone:732-682-6645
Mailing Address - Fax:
Practice Address - Street 1:1 WOODBROOK DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1901
Practice Address - Country:US
Practice Address - Phone:732-682-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-59936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst