Provider Demographics
NPI:1942365432
Name:JOVE-D'AMATO, MARTHA (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:JOVE-D'AMATO
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ONECO ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2936
Mailing Address - Country:US
Mailing Address - Phone:860-886-1451
Mailing Address - Fax:860-889-1242
Practice Address - Street 1:127 ONECO ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2936
Practice Address - Country:US
Practice Address - Phone:860-886-1451
Practice Address - Fax:860-889-1242
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000233237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO730000233-CT03OtherANTHEM BLUE CROSS