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General NPI Number Information
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NPI Number | 1265567119
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Entity Type | Individual
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Provider Name | PATRICIA D DEMATTEO EDD LCSW BCD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 202 S LEVITT ST
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City | ROME
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State | NY
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Zip | 13440-2910
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Country | US
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Telephone | 315-337-1311
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Fax | 315-337-1423
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Provider Business Mailing Address
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Address Line | PO BOX 1063 202 S. LEVITT ST
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City | ROME
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State | NY
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Zip | 13442-1063
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Country | US
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Telephone | 315-337-1311
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Fax | 315-337-1423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PRO243191
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | SCO 1393
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PRO243191
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SCO 1393
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License Number State | NJ
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