Provider Demographics
NPI:1942024294
Name:DAMON, TIARA-RUBY D (DOULA)
Entity type:Individual
Prefix:
First Name:TIARA-RUBY
Middle Name:D
Last Name:DAMON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2802
Mailing Address - Country:US
Mailing Address - Phone:718-971-0859
Mailing Address - Fax:
Practice Address - Street 1:476 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2802
Practice Address - Country:US
Practice Address - Phone:718-971-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty