Provider Demographics
NPI:1952424970
Name:DEMARCO, MARY ALICE (MED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALICE
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARY DEMARCO
Mailing Address - Street 2:35 ORCHARD STREET
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1017
Mailing Address - Country:US
Mailing Address - Phone:973-835-8294
Mailing Address - Fax:
Practice Address - Street 1:PATHWAYS COUNSELING CENTER, INC.
Practice Address - Street 2:16 POMPTON AVENUE
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07644-1895
Practice Address - Country:US
Practice Address - Phone:973-835-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNONE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health