Provider Demographics
NPI:1992109383
Name:ANDREW J. D'AMICO PH.D LLC
Entity type:Organization
Organization Name:ANDREW J. D'AMICO PH.D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-527-1051
Mailing Address - Street 1:1030 E LANCASTER AVE
Mailing Address - Street 2:SUITE L-10
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1451
Mailing Address - Country:US
Mailing Address - Phone:610-527-1051
Mailing Address - Fax:610-527-5577
Practice Address - Street 1:1030 E LANCASTER AVE
Practice Address - Street 2:SUITE L-10
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1451
Practice Address - Country:US
Practice Address - Phone:610-527-1051
Practice Address - Fax:610-527-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004905L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health