Provider Demographics
NPI:1356028518
Name:DEMARSH, MICHELLE M
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:DEMARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 LAUREL CRES
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-9017
Mailing Address - Country:US
Mailing Address - Phone:570-604-3069
Mailing Address - Fax:
Practice Address - Street 1:ABA SUPPORT SERVICES
Practice Address - Street 2:224 NAZARETH PIKE
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:610-365-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006518103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst