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General NPI Number Information
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NPI Number | 1780498345
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Entity Type | Individual
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Provider Name | DAMIAN ANTHONY CUSUMANO MSW, CSWA
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Gender | Male
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 760 NW HARRIMAN ST
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City | BEND
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State | OR
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Zip | 97703-2789
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Country | US
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Telephone | 541-316-0266
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Fax | 541-316-0266
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Provider Business Mailing Address
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Address Line | 2592 NW ELM AVE
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City | REDMOND
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State | OR
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Zip | 97756-5526
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Country | US
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Telephone | 484-459-0539
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | A15461
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License Number State | OR
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