Provider Demographics
NPI:1083904064
Name:ANDREA D'AMICO, LMFT, PLLC
Entity Type:Organization
Organization Name:ANDREA D'AMICO, LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:516-578-3827
Mailing Address - Street 1:650 HAWKINS AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2366
Mailing Address - Country:US
Mailing Address - Phone:516-578-3827
Mailing Address - Fax:631-615-6400
Practice Address - Street 1:650 HAWKINS AVE STE 5
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2366
Practice Address - Country:US
Practice Address - Phone:516-578-3827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty