Provider Demographics
NPI:1851940514
Name:RUMORE, DANTE SANDRO (LICSW)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:SANDRO
Last Name:RUMORE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINE ST STE 105A
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1369
Mailing Address - Country:US
Mailing Address - Phone:208-627-9930
Mailing Address - Fax:
Practice Address - Street 1:105 PINE ST STE 105A
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1369
Practice Address - Country:US
Practice Address - Phone:208-627-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604323031041C0700X
IDLCSW372451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical