Provider Demographics
NPI:1124157565
Name:DIMANNO, PETER (PETER DIMANNO)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:DIMANNO
Suffix:
Gender:M
Credentials:PETER DIMANNO
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:DIMANNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PETER DIMANNO LCSW
Mailing Address - Street 1:1503 N IMPERIAL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6301
Mailing Address - Country:US
Mailing Address - Phone:760-352-4773
Mailing Address - Fax:760-352-4747
Practice Address - Street 1:1503 N IMPERIAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6301
Practice Address - Country:US
Practice Address - Phone:760-352-4773
Practice Address - Fax:760-352-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS100841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical