Provider Demographics
NPI:1407269699
Name:DEMAIO, NICK III (MA; LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:
Last Name:DEMAIO
Suffix:III
Gender:M
Credentials:MA; LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ROLLING GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3321
Mailing Address - Country:US
Mailing Address - Phone:203-248-2116
Mailing Address - Fax:
Practice Address - Street 1:46 ROLLING GREEN RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3321
Practice Address - Country:US
Practice Address - Phone:203-248-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0050811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical