Provider Demographics
NPI:1962473124
Name:DIMATTEO, JUNE (AUD)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:DIMATTEO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5700
Mailing Address - Country:US
Mailing Address - Phone:401-331-9690
Mailing Address - Fax:401-331-9609
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-331-9690
Practice Address - Fax:401-331-9609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00041231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1594OtherNEIGHBORHOOD HEALTH PLAN
RI406913OtherBLUE CHIP OF RI
RI2381490OtherAETNA-HMO
RI22050-9OtherBLUE CROSS BLUE SHIELD
RI45-00043OtherUNITED HEALTH PLAN
RI7200133OtherAETNA-NON-HMO
RI7200133OtherAETNA-NON-HMO