Active NPI
John Robert Dimatteo, MSW,LCSW
- Clinical Social Worker
- Pueblo, CO
National Provider Identifier
1992882963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 692
- Practice address
- 1304 Chinook LN
Pueblo, CO 81001-1851 - Phone
- (719) 545-2746
- Fax
- (719) 584-0110
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 692 | CO | Primary |
Addresses
Primary practice location
1304 Chinook LN
Pueblo, CO 81001-1851
Mailing address
63 E Parkridge Dr
Pueblo West, CO 81007-1377
Phone (719) 547-3263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 692 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992882963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 E PARKRIDGE DR",
"city": "PUEBLO WEST",
"state": "CO",
"postal_code": "810071377",
"telephone_number": "719-547-3263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1304 CHINOOK LN",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011851",
"telephone_number": "719-545-2746",
"fax_number": "719-584-0110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIMATTEO",
"first_name": "JOHN",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "MSW,LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.