Provider Demographics
NPI:1295446888
Name:DEMEROTO, PATRICIA JEAN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:DEMEROTO
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 1:76 ARGYLE DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4302
Mailing Address - Country:US
Mailing Address - Phone:520-256-8705
Mailing Address - Fax:
Practice Address - Street 1:76 ARGYLE DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4302
Practice Address - Country:US
Practice Address - Phone:520-256-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical