Provider Demographics
NPI:1194709097
Name:DAMIANI, JOSEPH A (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:DAMIANI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17282 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3151
Mailing Address - Country:US
Mailing Address - Phone:734-762-9710
Mailing Address - Fax:734-762-9705
Practice Address - Street 1:17282 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3151
Practice Address - Country:US
Practice Address - Phone:734-762-9710
Practice Address - Fax:734-762-9705
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI099166OtherMANAGER HEALTH NETWORK
MI680H23998OtherBLUE CROSS BLUE SHIELD
MI680H23998OtherBLUE CROSS BLUE SHIELD