Provider Demographics
NPI:1851549786
Name:D'AMICO, MARY C
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ELBERT CT
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1011
Mailing Address - Country:US
Mailing Address - Phone:201-825-6751
Mailing Address - Fax:201-825-6751
Practice Address - Street 1:46 ELBERT CT
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1011
Practice Address - Country:US
Practice Address - Phone:201-825-6751
Practice Address - Fax:201-825-6751
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst