Provider Demographics
NPI:1053445312
Name:DAMOND, PATRICK J (LPC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:DAMOND
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1869
Mailing Address - Country:US
Mailing Address - Phone:814-812-9738
Mailing Address - Fax:814-790-5999
Practice Address - Street 1:1163 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1869
Practice Address - Country:US
Practice Address - Phone:814-812-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003590101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007320880002Medicaid
PA11663910OtherCAQH #
PA1007320880001Medicaid
PA1007320880002Medicaid