Provider Demographics
NPI:1831564228
Name:DEMERCHANT, DOUGLAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:DEMERCHANT
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 1:620 W ROOSEVELT RD STE D1
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2306
Mailing Address - Country:US
Mailing Address - Phone:630-462-1999
Mailing Address - Fax:630-462-0069
Practice Address - Street 1:620 W ROOSEVELT RD STE D1
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2306
Practice Address - Country:US
Practice Address - Phone:630-462-1999
Practice Address - Fax:630-462-0069
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical