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NPI Code Detail

MEDICARE: KRISTIE DAMON LMSW

MEDICARE: KRISTIE DAMON LMSW
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
1104100000XSocial Worker117641NY
21041C0700XClinical Social Worker102935-01NY

General Provider Information

NPI Number : 1306566682
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIE DAMON LMSW
Provider Business Mailing Address
First Line : 20604 COUNTY ROUTE 63
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-5557
Country : US
Telephone Number : 315-955-8441
Fax Number :
Provider Business Practice Location Address
First Line : 20604 COUNTY ROUTE 63
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-5557
Country : US
Telephone Number : 315-955-8441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2022
Last Update Date : 05/20/2026

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