Provider Demographics
NPI:1265567119
Name:DEMATTEO, PATRICIA D (EDD LCSW BCD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:D
Last Name:DEMATTEO
Suffix:
Gender:F
Credentials:EDD LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:202 S. LEVITT ST
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13442-1063
Mailing Address - Country:US
Mailing Address - Phone:315-337-1311
Mailing Address - Fax:315-337-1423
Practice Address - Street 1:202 S LEVITT ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2910
Practice Address - Country:US
Practice Address - Phone:315-337-1311
Practice Address - Fax:315-337-1423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO243191103T00000X, 1041C0700X
NJSCO 1393103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
54210BMedicare ID - Type Unspecified