Provider Demographics
NPI:1770746810
Name:DAMM STEWART, KARRIE D (MFT)
Entity type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:D
Last Name:DAMM STEWART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:KARRIE
Other - Middle Name:D
Other - Last Name:DAMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:792 N MAIN ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1661
Mailing Address - Country:US
Mailing Address - Phone:315-299-6975
Mailing Address - Fax:929-274-8307
Practice Address - Street 1:792 N MAIN ST STE 100B
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1661
Practice Address - Country:US
Practice Address - Phone:315-299-6975
Practice Address - Fax:929-274-8307
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist