Provider Demographics
NPI:1255974242
Name:DEAMICIS, ADRIANA (PHD)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:DEAMICIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATE ST APT 2612
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3626
Mailing Address - Country:US
Mailing Address - Phone:978-808-2894
Mailing Address - Fax:
Practice Address - Street 1:129 CHURCH ST STE 704
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2043
Practice Address - Country:US
Practice Address - Phone:203-479-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical