Provider Demographics
NPI:1639315500
Name:DIMAIO, JASMIN A (LCDP, ACDP)
Entity type:Individual
Prefix:MRS
First Name:JASMIN
Middle Name:A
Last Name:DIMAIO
Suffix:
Gender:F
Credentials:LCDP, ACDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N MAIN ST
Mailing Address - Street 2:4TH FLOOR SUITE 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5762
Mailing Address - Country:US
Mailing Address - Phone:401-437-8657
Mailing Address - Fax:401-528-0188
Practice Address - Street 1:530 N MAIN ST
Practice Address - Street 2:4TH FLOOR SUITE 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5762
Practice Address - Country:US
Practice Address - Phone:401-437-8657
Practice Address - Fax:401-528-0188
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIACDP163308101YA0400X
RICDP00463101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid