Basic Information
| Provider Information | |||||||||
| NPI: | 1780967000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIMEO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 MARKET ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154873000 | ||||||||
| FaxNumber: | 4155589657 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 MARKET ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154873000 | ||||||||
| FaxNumber: | 4155589657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2011 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF79056 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.