Provider Demographics
NPI:1255467395
Name:DAMATO, GABRIELLE (PHD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:DAMATO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S. 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1804
Mailing Address - Country:US
Mailing Address - Phone:315-402-2066
Mailing Address - Fax:315-402-2066
Practice Address - Street 1:157 EAST FIRST ST
Practice Address - Street 2:SUITE 10
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2641
Practice Address - Country:US
Practice Address - Phone:315-216-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010711-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01340505Medicaid
NYP821451OtherOXFORD HEALTH
NY6899911OtherGHI NUMBER
NYJ300000004Medicare UPIN
NYV96231Medicare PIN