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NPI Code Detail

MEDICARE: MR. PHIL RANDY D'AMICO LCSW

MEDICARE: MR. PHIL RANDY D'AMICO LCSW
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 Worker72076786NY

General Provider Information

NPI Number : 1487802484
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHIL RANDY D'AMICO LCSW
Provider Business Mailing Address
First Line : 2483 ARTHUR KILL RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-1207
Country : US
Telephone Number : 347-857-7449
Fax Number :
Provider Business Practice Location Address
First Line : 2483 ARTHUR KILL RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-1207
Country : US
Telephone Number : 347-857-7449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2008
Last Update Date : 08/08/2012

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