Provider Demographics
NPI:1093037608
Name:PETER DIMANNO LCSW APC
Entity Type:Organization
Organization Name:PETER DIMANNO LCSW APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMANNO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-352-4773
Mailing Address - Street 1:1503 N IMPERIAL AVE
Mailing Address - Street 2:205
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6301
Mailing Address - Country:US
Mailing Address - Phone:760-352-4773
Mailing Address - Fax:760-352-4747
Practice Address - Street 1:1503 N IMPERIAL AVE
Practice Address - Street 2:205
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6301
Practice Address - Country:US
Practice Address - Phone:760-352-4773
Practice Address - Fax:760-352-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS100841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty