Provider Demographics
NPI:1285919365
Name:AVINGER, DAMON VIDAL
Entity type:Individual
Prefix:MR
First Name:DAMON
Middle Name:VIDAL
Last Name:AVINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 KINGSBOROUGH 3RD WALK
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-3671
Mailing Address - Country:US
Mailing Address - Phone:718-493-0975
Mailing Address - Fax:
Practice Address - Street 1:610 E 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3601
Practice Address - Country:US
Practice Address - Phone:646-538-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0289761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical