Provider Demographics
NPI:1073822060
Name:DICKERSON, KELIN (MA)
Entity Type:Individual
Prefix:
First Name:KELIN
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1R NEWBURY ST STE 211
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3816
Mailing Address - Country:US
Mailing Address - Phone:978-276-4184
Mailing Address - Fax:
Practice Address - Street 1:1R NEWBURY ST STE 211
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3816
Practice Address - Country:US
Practice Address - Phone:978-276-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist