Provider Demographics
NPI:1417041971
Name:D'ADAMO, MICHAEL VINCENT (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:D'ADAMO
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 1:295 ROUTE 22 EAST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889
Mailing Address - Country:US
Mailing Address - Phone:908-534-5850
Mailing Address - Fax:
Practice Address - Street 1:295 ROUTE 22 EAST
Practice Address - Street 2:SUITE 3
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889
Practice Address - Country:US
Practice Address - Phone:908-534-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2645103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ813632Medicare UPIN
NJ813632Medicare ID - Type UnspecifiedPSYCHOLOGIST