Provider Demographics
NPI:1407937162
Name:DICKERSON COUNSELING & PSYCHOTHERAPY
Entity Type:Organization
Organization Name:DICKERSON COUNSELING & PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-475-8100
Mailing Address - Street 1:40 CASTNERS RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-2802
Mailing Address - Country:US
Mailing Address - Phone:908-475-8100
Mailing Address - Fax:908-475-8100
Practice Address - Street 1:40 CASTNERS RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-2802
Practice Address - Country:US
Practice Address - Phone:908-475-8100
Practice Address - Fax:908-475-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2202103TC0700X
NJ44SC0001431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty