Provider Demographics
NPI:1033274188
Name:DICKERSON, BARBARA JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JANE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:JANE
Other - Last Name:GUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3100 BROADWAY BLVD 410
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2655
Mailing Address - Country:US
Mailing Address - Phone:816-405-1341
Mailing Address - Fax:816-753-7744
Practice Address - Street 1:12600E US HIGHWAY 40 101
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5909
Practice Address - Country:US
Practice Address - Phone:816-405-1341
Practice Address - Fax:816-753-7744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0002711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496962101Medicaid
MO0007562Medicare ID - Type Unspecified