Provider Demographics
NPI:1477393163
Name:DEMATTEIS, ALEXANDER IV (EDD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:DEMATTEIS
Suffix:IV
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2682 VICTRON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3148
Mailing Address - Country:US
Mailing Address - Phone:314-657-7068
Mailing Address - Fax:
Practice Address - Street 1:1654 BRYAN RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4897
Practice Address - Country:US
Practice Address - Phone:636-344-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor