Provider Demographics
NPI:1942321989
Name:DE MARCHIS, MASSIMO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MASSIMO
Middle Name:
Last Name:DE MARCHIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1528
Mailing Address - Country:US
Mailing Address - Phone:937-684-2123
Mailing Address - Fax:937-294-1830
Practice Address - Street 1:732 BECKMAN ST
Practice Address - Street 2:NOVA HOUSE ASSOCIATION INC.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2165
Practice Address - Country:US
Practice Address - Phone:937-253-1680
Practice Address - Fax:937-253-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
OH4045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical