Provider Demographics
NPI:1689834855
Name:DAMUS, GINA (LMSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DAMUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9103
Mailing Address - Country:US
Mailing Address - Phone:631-873-4039
Mailing Address - Fax:631-873-4039
Practice Address - Street 1:492 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9103
Practice Address - Country:US
Practice Address - Phone:631-873-4039
Practice Address - Fax:631-873-4039
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker