Provider Demographics
NPI:1891728812
Name:MATTIMORE, JAMES F (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:MATTIMORE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16 WHITTEMORE RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3265
Mailing Address - Country:US
Mailing Address - Phone:508-877-9306
Mailing Address - Fax:508-877-5421
Practice Address - Street 1:16 WHITTEMORE RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3265
Practice Address - Country:US
Practice Address - Phone:508-877-9306
Practice Address - Fax:508-877-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27373-8OtherBLUECROSSBLUESHIELD
MA466870OtherTRICARE
MA1035230OtherFALLON HEALTH CARE
MA356487OtherBCBS MAGELLAN
MA792950OtherTUFTS HEALTH
MAP07565OtherBLUECROSSBLUESHIELD
MA115422OtherUNITED BEHAVIORAL HEALTH
MA466870OtherTRICARE