Provider Demographics
NPI:1477838704
Name:DICKINSON, JOSEPHINE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:ANN
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3112
Mailing Address - Country:US
Mailing Address - Phone:574-289-9700
Mailing Address - Fax:
Practice Address - Street 1:919 E JEFFERSON BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3112
Practice Address - Country:US
Practice Address - Phone:574-289-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20042312A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist