Provider Demographics
NPI:1972355287
Name:SHELLY D'AMATO LLC
Entity Type:Organization
Organization Name:SHELLY D'AMATO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-245-4014
Mailing Address - Street 1:14 PACIO CT
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1121
Mailing Address - Country:US
Mailing Address - Phone:201-245-4014
Mailing Address - Fax:
Practice Address - Street 1:14 PACIO CT
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1121
Practice Address - Country:US
Practice Address - Phone:201-245-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)