Provider Demographics
NPI:1417715327
Name:PASSAFIUME, ALEX (EDS)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:PASSAFIUME
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 ZEBULON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2756
Mailing Address - Country:US
Mailing Address - Phone:440-796-0932
Mailing Address - Fax:
Practice Address - Street 1:2700 E MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2581
Practice Address - Country:US
Practice Address - Phone:440-796-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.00714103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty