Provider Demographics
NPI:1053475111
Name:DICKER, DALE (MED LCSW)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:DICKER
Suffix:
Gender:M
Credentials:MED LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 ADMINISTRATION DR
Mailing Address - Street 2:STE 101
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-993-8123
Mailing Address - Fax:314-993-8123
Practice Address - Street 1:11715 ADMINISTRATION DR
Practice Address - Street 2:STE 101
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-993-8123
Practice Address - Fax:314-993-8123
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000956101YP2500X
MO0023201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical