Provider Demographics
NPI:1598973356
Name:DE MARNEFFE, COLETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:
Last Name:DE MARNEFFE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4540
Mailing Address - Country:US
Mailing Address - Phone:301-270-2711
Mailing Address - Fax:
Practice Address - Street 1:4828 WEST LN STE B
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6340
Practice Address - Country:US
Practice Address - Phone:301-891-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical