Provider Demographics
NPI:1568688588
Name:DAMON, DAVID ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:DAMON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SUMAC TRAIL
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-2412
Mailing Address - Country:US
Mailing Address - Phone:401-783-5824
Mailing Address - Fax:
Practice Address - Street 1:2364 POST RD
Practice Address - Street 2:SUITE 201 JUSTICE RESOURCE INSTITUTE INTEGRATED CLINICA
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-734-9317
Practice Address - Fax:401-734-9359
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor