Provider Demographics
NPI:1386028116
Name:DICKASON, JOAN
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:DICKASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5504
Mailing Address - Country:US
Mailing Address - Phone:908-889-7133
Mailing Address - Fax:
Practice Address - Street 1:140 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5504
Practice Address - Country:US
Practice Address - Phone:908-889-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator