MEDICARE: MS. ANDREA JEANINE D'AMICO LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	000050	NY

General Provider Information

NPI Number	:	1033172366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA JEANINE D'AMICO LMFT

Provider Business Mailing Address
First Line	:	36 BRILNER DRIVE
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-1646
Country	:	US
Telephone Number	:	516-578-3827
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 HAWKINS AVE STE 5
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-2366
Country	:	US
Telephone Number	:	516-578-3827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	10/13/2021

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