Provider Demographics
NPI:1013566181
Name:DANIEL DIMICK, MA, LP, LMFT, INC.
Entity Type:Organization
Organization Name:DANIEL DIMICK, MA, LP, LMFT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP, LMFT
Authorized Official - Phone:507-645-6575
Mailing Address - Street 1:105 4TH ST E STE 304
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2047
Mailing Address - Country:US
Mailing Address - Phone:507-645-6575
Mailing Address - Fax:507-645-7822
Practice Address - Street 1:105 4TH ST E STE 304
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2047
Practice Address - Country:US
Practice Address - Phone:507-645-6575
Practice Address - Fax:507-645-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty