Provider Demographics
NPI:1114207883
Name:DICKEY, MITCHELL (PHD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:DICKEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 THE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-2834
Mailing Address - Country:US
Mailing Address - Phone:203-625-8242
Mailing Address - Fax:
Practice Address - Street 1:32 FIELD POINT RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5338
Practice Address - Country:US
Practice Address - Phone:203-625-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2239OtherSTATE LICENSE AS PSYCHOLOGIST