Provider Demographics
NPI:1548380405
Name:DOUGLAS B. DEMERCHANT PSY.D., LLC
Entity Type:Organization
Organization Name:DOUGLAS B. DEMERCHANT PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-462-1999
Mailing Address - Street 1:620 W ROOSEVELT RD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5086
Mailing Address - Country:US
Mailing Address - Phone:630-462-1999
Mailing Address - Fax:630-462-0069
Practice Address - Street 1:620 W ROOSEVELT RD
Practice Address - Street 2:SUITE D1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5086
Practice Address - Country:US
Practice Address - Phone:630-462-1999
Practice Address - Fax:630-462-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty