Healthcare Provider Details

I. General information

NPI: 1780498345
Provider Name (Legal Business Name): DAMIAN ANTHONY CUSUMANO MSW, CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NW HARRIMAN ST
BEND OR
97703-2789
US

IV. Provider business mailing address

2592 NW ELM AVE
REDMOND OR
97756-5526
US

V. Phone/Fax

Practice location:
  • Phone: 541-316-0266
  • Fax: 541-316-0266
Mailing address:
  • Phone: 484-459-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA15461
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: