Provider Demographics
NPI:1972269553
Name:MICHELLE D'AMICO LICSW LLC
Entity Type:Organization
Organization Name:MICHELLE D'AMICO LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-560-3112
Mailing Address - Street 1:55 SPENCER ST UNIT 170
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-2484
Mailing Address - Country:US
Mailing Address - Phone:978-560-3112
Mailing Address - Fax:
Practice Address - Street 1:1R NEWBURY ST STE 207
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3816
Practice Address - Country:US
Practice Address - Phone:978-560-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty