Provider Demographics
NPI:1568590131
Name:DAMATO, DENNIS (MSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:DAMATO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WOODYCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1714
Mailing Address - Country:US
Mailing Address - Phone:631-654-4726
Mailing Address - Fax:631-654-4726
Practice Address - Street 1:221 WOODYCREST DR
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1714
Practice Address - Country:US
Practice Address - Phone:631-654-4726
Practice Address - Fax:631-654-4726
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049104-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7Q461Medicare ID - Type Unspecified