Provider Demographics
NPI:1245653476
Name:DAMICO, JULIE (LICSW)
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:
Last Name:DAMICO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:HUNNEWELL GROUND - CHPCC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7664
Mailing Address - Fax:617-730-0505
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:HUNNEWELL GROUND - CHPCC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7664
Practice Address - Fax:617-730-0505
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2184071041C0700X
1188461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical