Provider Demographics
NPI:1376803213
Name:DEMARCO, JESSICA MACK (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MACK
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:6829 N 72ND ST
Practice Address - Street 2:SUITE 4700
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1723
Practice Address - Country:US
Practice Address - Phone:402-572-2169
Practice Address - Fax:402-572-3479
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE849103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist