Provider Demographics
NPI:1629750203
Name:DAMERVAL, JEREMY (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:DAMERVAL
Suffix:
Gender:M
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 NE ST JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2561
Mailing Address - Country:US
Mailing Address - Phone:360-909-0231
Mailing Address - Fax:
Practice Address - Street 1:4420 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2561
Practice Address - Country:US
Practice Address - Phone:360-909-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60842501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty