Provider Demographics
NPI:1942583901
Name:DIMATTEO, LAURA G (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:DIMATTEO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:G
Other - Last Name:KAPLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1120 SILO WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1691
Mailing Address - Country:US
Mailing Address - Phone:727-538-4208
Mailing Address - Fax:727-538-4209
Practice Address - Street 1:1120 SILO WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1691
Practice Address - Country:US
Practice Address - Phone:727-538-4208
Practice Address - Fax:727-538-4209
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1177611041C0700X
TN66591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034244Medicaid