Provider Demographics
NPI:1558615252
Name:DEMADERIOS, DONALD G (MA, MFTI, LPCCI)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:DEMADERIOS
Suffix:
Gender:M
Credentials:MA, MFTI, LPCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-677-7808
Mailing Address - Fax:310-846-2139
Practice Address - Street 1:4760 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4820
Practice Address - Country:US
Practice Address - Phone:310-389-5230
Practice Address - Fax:310-398-5690
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist