Provider Demographics
NPI:1558636084
Name:DIMATTEO, ANDREA M (MA, CASAC)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:M
Last Name:DIMATTEO
Suffix:
Gender:F
Credentials:MA, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2709
Mailing Address - Country:US
Mailing Address - Phone:631-271-3591
Mailing Address - Fax:631-271-5497
Practice Address - Street 1:243 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2709
Practice Address - Country:US
Practice Address - Phone:631-271-3591
Practice Address - Fax:631-271-5497
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)