1194151092 NPI number — MARIE ANN DEMCHAK-BUOTTE PSYD, M.A.

Table of content: MARIE ANN DEMCHAK-BUOTTE PSYD, M.A. (NPI 1194151092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194151092 NPI number — MARIE ANN DEMCHAK-BUOTTE PSYD, M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMCHAK-BUOTTE
Provider First Name:
MARIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD, M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194151092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51913 ANNIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT VALLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12569-7979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-820-0656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 FABER PLACE DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29405-8585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-803-1894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2016 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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