Provider Demographics
NPI:1831662915
Name:DAMM, KIERAN JONATHAN
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:JONATHAN
Last Name:DAMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 HEMLOCK LANE
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26547
Mailing Address - Country:US
Mailing Address - Phone:304-904-1532
Mailing Address - Fax:
Practice Address - Street 1:131 BAKERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1459
Practice Address - Country:US
Practice Address - Phone:301-873-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports