Healthcare Provider Details

I. General information

NPI: 1124142104
Provider Name (Legal Business Name): CYNTHIA D'AMICO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W MILLBROOK RD SUITE A
RALEIGH NC
27609-4304
US

IV. Provider business mailing address

1120 FALLS BRIDGE DRIVE
RALEIGH NC
27614
US

V. Phone/Fax

Practice location:
  • Phone: 919-846-6442
  • Fax:
Mailing address:
  • Phone: 919-676-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1546
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: