Basic Information
Provider Information
NPI: 1003002676
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMARIA
FirstName: DANIELLE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: 1322 N ACADEMY BLVD
Address2: STE. 202
City: COLORADO SPRINGS
State: CO
PostalCode: 809093317
CountryCode: US
TelephoneNumber: 7194288939
FaxNumber: 7192189001
Practice Location
Address1: 1322 N ACADEMY BLVD
Address2: STE. 202
City: COLORADO SPRINGS
State: CO
PostalCode: 809093317
CountryCode: US
TelephoneNumber: 7194288939
FaxNumber: 7192189001
Other Information
ProviderEnumerationDate: 09/18/2007
LastUpdateDate: 08/18/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X48122CAN Behavioral Health & Social Service ProvidersMarriage & Family Therapist 
106H00000X919COY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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