Healthcare Provider Details

I. General information

NPI: 1962473124
Provider Name (Legal Business Name): JUNE DIMATTEO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MAIN ST SUITE 2
PROVIDENCE RI
02904-5700
US

IV. Provider business mailing address

845 N MAIN ST SUITE 2
PROVIDENCE RI
02904-5700
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-9690
  • Fax: 401-331-9609
Mailing address:
  • Phone: 401-331-9690
  • Fax: 401-331-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00041
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: