Provider Demographics
NPI:1831607787
Name:DIMOND, MATTHEW (LICSW-A, MSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DIMOND
Suffix:
Gender:M
Credentials:LICSW-A, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PELLY AVE N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5714
Mailing Address - Country:US
Mailing Address - Phone:206-899-9940
Mailing Address - Fax:206-899-9940
Practice Address - Street 1:119 PELLY AVE N
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5714
Practice Address - Country:US
Practice Address - Phone:206-899-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10382599-3502104100000X
WASC609688021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker