Provider Demographics
NPI:1659420107
Name:DERAMO, THERESA LOUISE (MAC LAC, DIPLAC)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:LOUISE
Last Name:DERAMO
Suffix:
Gender:F
Credentials:MAC LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 MARCEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1912
Mailing Address - Country:US
Mailing Address - Phone:443-306-0560
Mailing Address - Fax:301-498-5657
Practice Address - Street 1:3633 MARCEY CREEK RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1912
Practice Address - Country:US
Practice Address - Phone:443-306-0560
Practice Address - Fax:301-498-5657
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist