MEDICARE: ANDREA D'AMICO, LMFT, PLLC

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	:	1083904064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREA D'AMICO, LMFT, PLLC

Provider Business Mailing 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	:	631-615-6400

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	:	OWNER
Name	:	ANDREA D'AMICO
Credential	:	M.A., LMFT
Telephone Number	:	516-578-3827

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	10/13/2021

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