Healthcare Provider Details

I. General information

NPI: 1841636743
Provider Name (Legal Business Name): DAMIEN DION WADE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 O ST NW
WASHINGTON DC
20001-1259
US

IV. Provider business mailing address

1130 KAYAK AVE
CAPITOL HEIGHTS MD
20743-4043
US

V. Phone/Fax

Practice location:
  • Phone: 202-797-8806
  • Fax:
Mailing address:
  • Phone: 347-528-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: