Provider Demographics
NPI:1003245242
Name:DIMAS, JES (LCSW, LICSW, LSSW)
Entity Type:Individual
Prefix:MR
First Name:JES
Middle Name:
Last Name:DIMAS
Suffix:
Gender:M
Credentials:LCSW, LICSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 STATE ST STE 270
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3647
Mailing Address - Country:US
Mailing Address - Phone:503-583-2121
Mailing Address - Fax:855-855-4872
Practice Address - Street 1:494 STATE ST STE 270
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3647
Practice Address - Country:US
Practice Address - Phone:503-583-2121
Practice Address - Fax:855-855-4872
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609939771041C0700X
OR4317361041S0200X
ORL82211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500688776Medicaid