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NPI Code Detail

MEDICARE: MR. JOHN ROBERT DIMATTEO MSW,LCSW

MEDICARE: MR. JOHN ROBERT DIMATTEO MSW,LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker692CO

General Provider Information

NPI Number : 1992882963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN ROBERT DIMATTEO MSW,LCSW
Provider Business Mailing Address
First Line : 63 E PARKRIDGE DR
Second Line :
City : PUEBLO WEST
State : CO
Zip : 81007-1377
Country : US
Telephone Number : 719-547-3263
Fax Number :
Provider Business Practice Location Address
First Line : 1304 CHINOOK LN
Second Line :
City : PUEBLO
State : CO
Zip : 81001-1851
Country : US
Telephone Number : 719-545-2746
Fax Number : 719-584-0110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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