Provider Demographics
NPI:1336176205
Name:DEMARCO, JOHN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1017
Mailing Address - Country:US
Mailing Address - Phone:973-835-8294
Mailing Address - Fax:
Practice Address - Street 1:913 ROUTE 23 SOUTH
Practice Address - Street 2:SUITE 14
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1069
Practice Address - Country:US
Practice Address - Phone:973-224-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00115000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional