Provider Demographics
NPI:1568681047
Name:DEMERTZIS, HOPE DELANE (MSW, PD)
Entity Type:Individual
Prefix:MS
First Name:HOPE
Middle Name:DELANE
Last Name:DEMERTZIS
Suffix:
Gender:F
Credentials:MSW, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0489
Mailing Address - Country:US
Mailing Address - Phone:516-582-4673
Mailing Address - Fax:
Practice Address - Street 1:101 HILLSIDE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2347
Practice Address - Country:US
Practice Address - Phone:516-582-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR041648-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3I711Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER