Provider Demographics
NPI:1154079390
Name:D'AMATO, MAEGAN A (LCSW)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:A
Last Name:D'AMATO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2620
Mailing Address - Country:US
Mailing Address - Phone:347-749-3408
Mailing Address - Fax:
Practice Address - Street 1:575 GREEN LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2620
Practice Address - Country:US
Practice Address - Phone:347-749-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0224451041C0700X
NY0833991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical