Provider Demographics
NPI:1417014689
Name:DYER, SONYA R
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:R
Last Name:DYER
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 1:1131 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-6418
Mailing Address - Country:US
Mailing Address - Phone:302-422-8026
Mailing Address - Fax:302-422-0701
Practice Address - Street 1:1131 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6418
Practice Address - Country:US
Practice Address - Phone:302-422-8026
Practice Address - Fax:302-422-0701
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100006091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025151Medicaid