Provider Demographics
NPI:1053853093
Name:DAMON, MICHAEL (MSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DAMON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 GRANT AVE S
Mailing Address - Street 2:E3
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3668
Mailing Address - Country:US
Mailing Address - Phone:206-972-9545
Mailing Address - Fax:
Practice Address - Street 1:1850 GRANT AVE S
Practice Address - Street 2:E3
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-3668
Practice Address - Country:US
Practice Address - Phone:206-972-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC606592441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical