Provider Demographics
NPI:1932766961
Name:GIAMPINO, DOMENIC (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DOMENIC
Middle Name:
Last Name:GIAMPINO
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 BROADWAY # 560
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7302
Mailing Address - Country:US
Mailing Address - Phone:212-256-1071
Mailing Address - Fax:888-543-9475
Practice Address - Street 1:1370 BROADWAY # 560
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7302
Practice Address - Country:US
Practice Address - Phone:212-256-1071
Practice Address - Fax:888-543-9475
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical