Provider Demographics
NPI:1245394733
Name:DIMITRI, ROBERT H (PHD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:DIMITRI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:17 MEREDITH ROAD
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0131
Mailing Address - Country:US
Mailing Address - Phone:508-477-1176
Mailing Address - Fax:508-477-1176
Practice Address - Street 1:17 MEREDITH ROAD
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-0131
Practice Address - Country:US
Practice Address - Phone:508-477-1176
Practice Address - Fax:508-477-1176
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1274101YM0800X, 103TC1900X
MA201242104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker