Provider Demographics
NPI:1528228475
Name:D'AMICO, AUGUSTA (LCSW)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2416
Mailing Address - Country:US
Mailing Address - Phone:732-956-6614
Mailing Address - Fax:732-671-7803
Practice Address - Street 1:340 ROUTE 34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2433
Practice Address - Country:US
Practice Address - Phone:732-956-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076829-1104100000X
NJ44SC054086001041C0700X
NY0789461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker