Provider Demographics
NPI:1073069639
Name:WING, DAMIJTA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:DAMIJTA
Middle Name:
Last Name:WING
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:DAMIJTA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:510 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2100
Mailing Address - Country:US
Mailing Address - Phone:302-327-9215
Mailing Address - Fax:
Practice Address - Street 1:510 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2100
Practice Address - Country:US
Practice Address - Phone:302-327-9215
Practice Address - Fax:302-348-9028
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
DE1-22-57491103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist