Provider Demographics
NPI:1285708099
Name:MILLER DAMATO, CATHERINE HELEN (LCSW-R)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:HELEN
Last Name:MILLER DAMATO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E 90TH ST
Mailing Address - Street 2:2-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3540
Mailing Address - Country:US
Mailing Address - Phone:347-772-4200
Mailing Address - Fax:
Practice Address - Street 1:246 EAST 90 STREET 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:347-537-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYD745141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03062200Medicaid