Provider Demographics
NPI:1609187814
Name:DAMIAN, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DAMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 43RD ST
Mailing Address - Street 2:APT # 2H
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2106
Mailing Address - Country:US
Mailing Address - Phone:646-852-4978
Mailing Address - Fax:
Practice Address - Street 1:2805 43RD ST
Practice Address - Street 2:APT # 2H
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2106
Practice Address - Country:US
Practice Address - Phone:646-852-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist