Provider Demographics
NPI:1215444005
Name:D'AMICO, NICHOLAS (LMFT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3157
Mailing Address - Country:US
Mailing Address - Phone:319-261-2292
Mailing Address - Fax:
Practice Address - Street 1:1655 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3157
Practice Address - Country:US
Practice Address - Phone:319-261-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080327106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist