Provider Demographics
NPI:1881624302
Name:DEMARCO, PATRICK FRANCIS (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:FRANCIS
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 NORTHWEST AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9077
Mailing Address - Country:US
Mailing Address - Phone:360-526-8685
Mailing Address - Fax:
Practice Address - Street 1:4029 NORTHWEST AVE STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9077
Practice Address - Country:US
Practice Address - Phone:360-526-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60577725103TC0700X
CO2275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51856531Medicaid
WA2078884Medicaid
CO51856531Medicaid