Provider Demographics
NPI:1588937320
Name:PRATT, DAMIEN (LCSW, CASAC 2)
Entity type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:LCSW, CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 60TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4968
Mailing Address - Country:US
Mailing Address - Phone:347-610-9876
Mailing Address - Fax:
Practice Address - Street 1:4601 GREENPOINT AVE APT 2C
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1786
Practice Address - Country:US
Practice Address - Phone:347-610-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22852101YA0400X
NY0871611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)