Provider Demographics
NPI:1316451750
Name:MONTASSI, DAMIEN RAPHAEL (LSW)
Entity type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:RAPHAEL
Last Name:MONTASSI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 RIDGEBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1102
Mailing Address - Country:US
Mailing Address - Phone:440-840-7725
Mailing Address - Fax:
Practice Address - Street 1:5001 RIDGEBURY BLVD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1102
Practice Address - Country:US
Practice Address - Phone:440-953-9999
Practice Address - Fax:440-918-3839
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.1701621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator