Provider Demographics
NPI:1336326495
Name:BAMISILE, DAMMY (MSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAMMY
Middle Name:
Last Name:BAMISILE
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BURRITT AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5657
Mailing Address - Country:US
Mailing Address - Phone:203-380-1139
Mailing Address - Fax:
Practice Address - Street 1:61 BRIDGEPORT AVE STE 2
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3285
Practice Address - Country:US
Practice Address - Phone:203-520-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical