Basic Information
| Provider Information | |||||||||
| NPI: | 1760565907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMICO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 OLD FIELD PL | ||||||||
| Address2: | |||||||||
| City: | SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117331635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317512734 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 445 OAK ST | ||||||||
| Address2: | |||||||||
| City: | COPIAGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117263111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316917080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R016393-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.