Provider Demographics
NPI:1588645824
Name:DIMEO, ROBERT (LICSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DIMEO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:978-256-1943
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:978-256-1943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1054051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0022320OtherBEACON HEALTH STRATEGIES
MA0022320OtherMANGED HEALTH NETWORK
MA800009595OtherRAILROAD MEDICARE
MA1037106OtherCIGNA
MA043476807-06OtherPACIFICARE
NH1401857Y0MA02OtherANTHEM BCBS
MA462608000OtherMAGELLAN
MA730957OtherTUFTS
MAP03482OtherBCBSMA
MAP03482Medicare ID - Type Unspecified