Katelynn Damico, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

095564 Issued in NY

Practice address

475 E Main St Ste 100
East Patchogue, NY 11772-3121

Phone

(631) 286-8282

Fax

(631) 438-0882

NPI assigned

Aug 22, 2014

Last updated

Jun 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1316347651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 E MAIN ST STE 100",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117723121",
            "telephone_number": "631-286-8282",
            "fax_number": "631-438-0882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 E MAIN ST STE 100",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117723121",
            "telephone_number": "631-286-8282",
            "fax_number": "631-438-0882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMICO",
        "first_name": "KATELYNN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-22",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "101061",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "095564",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer M Cushman, MD
• Viviana Rosa Dadd, NP
• Neddy Louise Dallego
• John Joseph Dalton, PA-C
• Ellyse Damiano, PA
• Mallory R Datz
• Lauren Ann Davidson, RN
• Rodney E Davis, RPA-C
• Ashley Marie Defournoy, FNP, RN
• Joanne M Della Valle, LCSW

• Clinical Social Worker in East Patchogue, NY
• Providers in East Patchogue, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.