Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP019321 | PA |
NPI | 1023593191 |
---|---|
Provider Name | Richard Michael Damato |
First Address | Philadelphia, PA 19102-3610 |
Second Address | Philadelphia, PA 19102-3610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 20/05/2021 |