Provider Demographics
NPI:1821386012
Name:WADSWORTH, DAMON ARTHUR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:ARTHUR
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W 23RD ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2148
Mailing Address - Country:US
Mailing Address - Phone:212-727-8538
Mailing Address - Fax:212-727-8538
Practice Address - Street 1:455 W 23RD ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2148
Practice Address - Country:US
Practice Address - Phone:212-727-8538
Practice Address - Fax:212-727-8538
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003766-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health