Basic Information
| Provider Information | |||||||||
| NPI: | 1447689138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | D'AMICO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 WOODLANE ROAD | ||||||||
| Address2: | |||||||||
| City: | MT. HOLLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092675928 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 79 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080481134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095185470 | ||||||||
| FaxNumber: | 6095185484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 44SL05754600 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.