Provider Demographics
NPI:1629215124
Name:DIMARTINO, ANTHONY ROBERT JR (MSW, CASAC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:DIMARTINO
Suffix:JR
Gender:M
Credentials:MSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 S BUCKHOUT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2206
Mailing Address - Country:US
Mailing Address - Phone:718-579-7344
Mailing Address - Fax:718-579-7356
Practice Address - Street 1:401 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-4037
Practice Address - Country:US
Practice Address - Phone:718-579-7344
Practice Address - Fax:718-579-7356
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11883101YA0400X
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker