Provider Demographics
NPI:1780498345
Name:CUSUMANO, DAMIAN ANTHONY (MSW, CSWA)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:ANTHONY
Last Name:CUSUMANO
Suffix:
Gender:M
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 NW ELM AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-5526
Mailing Address - Country:US
Mailing Address - Phone:484-459-0539
Mailing Address - Fax:
Practice Address - Street 1:760 NW HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2789
Practice Address - Country:US
Practice Address - Phone:541-316-0266
Practice Address - Fax:541-316-0266
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA154611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical